Po-05-185 prediction and risk of atrial fibrillation in patients with hypertrophic cardiomyopathy: a danish nationwide cohort study

Hypertrophic cardiomyopathy (HCM) can be associated with serious complications such as heart failure, atrial fibrillation (AF) and sudden cardiac death. The treatment of AF in HCM patients can be challenging since AF often aggravates symptoms and increases the risk of stroke. Little is known on which factors contribute to the development of AF in these patients. To determine the incidence of AF in Danish HCM patients, identify risk factors for the development of AF and possible prediction tools for at-risk patients Through the Danish National Registers all patients without previous AF, aged 16 or older diagnosed with HCM between the 1st of January 2005, and the 31st of December 2018 were included in the analysis. The association between HCM and incident AF was investigated using multivariable Cox proportional-hazard analysis and odds ratios using linear regression. Cumulative incidence of AF was calculated using the Aalen-Johansen estimator, taking death as a competing risk into account. A total of 3,200 HCM patients without prevalent AF were included, median age was 66 years (IQR 55-77) and 48% were female. During the study period, 477 (15%) patients were diagnosed with incident AF. Risk of developing AF was increased for patients with obstructive HCM (HR 1.27 [95%CI 1.06 -1.53], p = 0.001) while there was no difference between genders. In patients classified as non-obstructive HCM, AF incidence likewise increased with rising CHADS-VASC score, however in the obstructive HCM category, AF incidence was high regardless of patients CHADS-VASC score. Further, for patients with non-obstructive HCM the odds ratio for incidental AF increased incrementally with rising CHADS-VASC score, while the CHADS-VASC score for patients with obstructive HCM followed no significant pattern. AF is a common complication in HCM. Patients with obstructive HCM were at increased risk of developing AF. The CHADS-VASC score is a potentially useful tool in identifying patients at risk for AF with non-obstructive HCM, however not in the presence of obstructive HCM.Tabled 1All patients and incident atrial fibrillationAll patientsWithout incident AFIncident AFNumber of patients32002723477Age: median in years (median [IQR])66 [54, 77]65 [53, 76]69 [59, 77]Gender: Female (%)1526 (48)1294 (47)232 (49)Age at or above 60 (%)2052 (64)1698 (62)354 (74)HCM type: obstructive (%)1477 (46)1211 (45)266 (56)Comorbidities:Hypertension (%)1490 (47)1216 (45)274 (57)Ischemic heart disease (%)640 (20)509 (19)131 (28)Heart failure (%)330 (10)276 (10)54 (11)Stroke (%)201 (6)174 (6)27 (6)Chronic obstructive pulmonary disease (%)231 (7)194 (7)37 (8)Chronic kidney disease (%)142 (4)126 (5)16 (3)CHADS - VASC ScoreCHADS - VASC = 0 (%)631 (20)575 (21)56 (12)CHADS - VASC = 1 (%)680 (21)591 (22)89 (19)CHADS - VASC = 2 (%)627 (20)515 (19)112 (23)CHADS - VASC = 3 (%)565 (18)470 (17)98 (20)CHADS - VASC = >3 (%)693 (21)571 (21)122 (26) Open table in a new tab