Prognosis

The prognosis of new-onset AF is not a well evaluated area. Prognosis depends on several factors, such as the precipitating event, underlying cardiac status, risk of thromboembolism, and whether the nature of the AF is paroxysmal, persistent, or permanent.[161] As well as its role in predicting thromboembolic risk, the CHA2DS2-VASc score is also useful at predicting recurrence of AF after electrical or pharmacologic cardioversion, with a score of ≥2 associated with a 37% increase in the risk of arrhythmia recurrence.[161] In young patients with no structural cardiac abnormalities who have an episode of new-onset AF as a result of alcohol bingeing, prognosis is excellent with avoidance of alcohol. Even in patients for whom alcohol was not a precipitant of AF, abstinence from alcohol can help reduce the risk of AF recurrence, and of ischemic stroke.[24][25][47][162] In contrast, short- and long-term prognosis for patients presenting with new onset of AF with heart failure following myocardial infarction (MI) is poor. Furthermore, a meta-analysis has shown that there is an increased risk of mortality with the presence of AF in the setting of MI, which persists regardless of the timing of AF.[163] Patients with prior AF or new-onset AF following MI need close clinical follow-up. One systematic review identified lower socioeconomic status as a risk factor for poor outcomes in AF.[164] Patients with a normal body mass index have the best outcomes in AF, with studies suggesting that the extremes of weight, either under- or overweight, are associated with a worse prognosis in AF.[165]

Use of this content is subject to our disclaimer