Predictors and prognosis of paroxysmal atrial fibrillation in general practice in the UK

BMC Cardiovasc Disord. 2005 Jul 11;5:20. doi: 10.1186/1471-2261-5-20.


Background: Natural history of paroxysmal atrial fibrillation (AF) is not very well documented. Clinical experience suggests that paroxysmal AF could progress to chronic AF with estimates ranging between 15 and 30% over a period of 1-3 years. We performed an epidemiologic study to elucidate the natural history of paroxysmal AF, this study estimated its incidence in a general practice setting, identified associated factors and analyzed the progression into chronic AF as well as the mortality rate.

Methods: Using the UK General Practice Research Database (GPRD), we identified patients aged 40-89 years with a first-recorded episode of paroxysmal AF during 1996. Risk factors were assessed using 525 incident paroxysmal AF cases confirmed by the general practitioner (GP) and a random sample of controls. We follow-up paroxysmal AF patients and estimated their mortality rate and progression to chronic AF.

Results: The incidence of paroxysmal AF was 1.0 per 1,000 person-years. Major risk factors for paroxysmal AF were age and prior valvular heart disease, ischaemic heart disease, heart failure and hyperthyroidism. During a mean follow-up of 2.7 years, 70 of 418 paroxysmal AF patients with complete information progressed to chronic AF. Risk factors associated with progression were valvular heart disease (OR 2.7, 95% CI 1.2-6.0) and moderate to high alcohol consumption (OR 3.0, 95% CI 1.1-8.0). Paroxysmal AF patients did not carry an increased risk of mortality, compared to an age and sex matched sample of the general population. There was a suggestion of a small increased risk among patients progressing to chronic AF (RR 1.5, 96% CI 0.8-2.9).

Conclusion: Paroxysmal AF is a common arrhythmia in the general practice setting, increasing with age and commonly associated with other heart diseases. It sometimes is the initial presentation and then progress to chronic AF. A history of valvular heart disease and alcohol consumption are associated with this progression.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Alcohol Drinking / epidemiology
  • Atrial Fibrillation / epidemiology*
  • Atrial Fibrillation / etiology
  • Atrial Fibrillation / mortality
  • Cardiovascular Diseases / complications
  • Chronic Disease
  • Family Practice
  • Female
  • Humans
  • Hyperthyroidism / complications
  • Incidence
  • Male
  • Middle Aged
  • Prognosis
  • Risk Factors
  • United Kingdom / epidemiology