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BackgroundThe incidence and predictors of atrial fibrillation (AF) progression are currently not well defined, and clinical AF progression partly overlaps with rhythm control interventions (RCIs).Methods and ResultsWe assessed AF type and intercurrent RCIs during yearly follow‐ups in 2869 prospectively followed patients with paroxysmal or persistent AF. Clinical AF progression was defined as progression from paroxysmal to nonparoxysmal or from persistent to permanent AF. An RCI was defined as pulmonary vein isolation, electrical cardioversion, or new treatment with amiodarone. During a median follow‐up of 3 years, the incidence of clinical AF progression was 5.2 per 100 patient‐years, and 10.9 per 100 patient‐years for any RCI. Significant predictors for AF progression were body mass index (hazard ratio [HR], 1.03; 95% CI, 1.01–1.05), heart rate (HR per 5 beats/min increase, 1.05; 95% CI, 1.02–1.08), age (HR per 5‐year increase 1.19; 95% CI, 1.13–1.27), systolic blood pressure (HR per 5 mm Hg increase, 1.03; 95% CI, 1.00–1.05), history of hyperthyroidism (HR, 1.71; 95% CI, 1.16–2.52), stroke (HR, 1.50; 95% CI, 1.19–1.88), and heart failure (HR, 1.69; 95% CI, 1.34–2.13). Regular physical activity (HR, 0.80; 95% CI, 0.66–0.98) and previous pulmonary vein isolation (HR, 0.69; 95% CI, 0.53–0.90) showed an inverse association. Significant predictive factors for RCIs were physical activity (HR, 1.42; 95% CI, 1.20–1.68), AF‐related symptoms (HR, 1.84; 95% CI, 1.47–2.30), age (HR per 5‐year increase, 0.88; 95% CI, 0.85–0.92), and paroxysmal AF (HR, 0.61; 95% CI, 0.51–0.73).ConclusionsCardiovascular risk factors and comorbidities were key predictors of clinical AF progression. A healthy lifestyle may therefore reduce the risk of AF progression.

Aims Atrial fibrillation (AF) and frailty are common, and the prevalence is expected to rise further. We aimed to investigate the prevalence of frailty and the ability of a frailty index (FI) to predict unplanned hospitalizations, stroke, bleeding, and death in patients with AF. Methods and results Patients with known AF were enrolled in a prospective cohort study in Switzerland. Information on medical history, lifestyle factors, and clinical measurements were obtained. The primary outcome was unplanned hospitalization; secondary outcomes were all-cause mortality, bleeding, and stroke. The FI was measured using a cumulative deficit approach, constructed according to previously published criteria and divided into three groups (non-frail, pre-frail, and frail). The association between frailty and outcomes was assessed using multivariable-adjusted Cox regression models. Of the 2369 included patients, prevalence of pre-frailty and frailty was 60.7% and 10.6%, respectively. Pre-frailty and frailty were associated with a higher risk of unplanned hospitalizations [adjusted hazard ratio (aHR) 1.82, 95% confidence interval (CI) 1.49–2.22; P < 0.001; and aHR 3.59, 95% CI 2.78–4.63, P < 0.001], all-cause mortality (aHR 5.07, 95% CI 2.43–10.59; P < 0.001; and aHR 16.72, 95% CI 7.75–36.05; P < 0.001), and bleeding (aHR 1.53, 95% CI 1.11–2.13; P = 0.01; and aHR 2.46, 95% CI 1.61–3.77; P < 0.001). Frailty, but not pre-frailty, was associated with a higher risk of stroke (aHR 3.29, 95% CI 1.2–8.39; P = 0.01). Conclusion Over two-thirds of patients with AF are pre-frail or frail. These patients have a high risk for unplanned hospitalizations and other adverse events. These findings emphasize the need to carefully evaluate these patients. However, whether screening for pre-frailty and frailty and targeted prevention strategies improve outcomes needs to be shown in future studies. Clinical trial registration Clinicaltrials.gov identifier number: NCT02105844.