No abstract

A trial fibrillation (AF) is the most common cardiac arrhythmia in developed countries and increases the risks for stroke, heart failure, and death.1 Until 2 decades ago, the incidence and risk factors for stroke were less well characterized in patients with paroxysmal AF (PAF) when compared with those with persistent or permanent AF.2,3 Since then, several studies have reported that patients with PAF have a risk of thromboembolic events that was similar to that in persistent or permanent AF. [4][5][6][7] In accordance with the results from these studies, current guidelines worldwide recommend the use of oral anticoagulant (OAC) for the prevention of thromboembolism, irrespective of the type of AF. [8][9][10] However, more recent studies have reported that the patients with PAF had a lower rate of stroke/systemic embolism (SE). 11-13Also, patients with PAF are less likely to receive OAC therapy in the real-world clinical practice.6,14 However, limited data on stroke risk associated with PAF are evident in Asian populations with PAF because most studies were epidemiological studies on Western populations or selected clinical trial cohorts.Background and Purpose-There is controversy on the relationship of the type of atrial fibrillation (AF) to stroke.Although several studies show that patients with paroxysmal AF (PAF) have a stroke risk similar to those with persistent or permanent AF, recent studies suggest that PAF is associated with a lower rate of stroke. Limited data on stroke risk associated with PAF are evident in Asian populations. Methods-The Registry Study of Atrial Fibrillation Patients in Fushimi-ku (Fushimi AF Registry) is a community-basedsurvey of patients with AF in Fushimi-ku, Kyoto, Japan. Patients were categorized into 2 types of AF: PAF or sustained (persistent or permanent) AF. We compared clinical events between PAF (n=1588) and sustained AF (n=1716). Results-Patients with PAF were younger, had less comorbidities, and received oral anticoagulants (OAC) less commonly.A lower risk of stroke/systemic embolism during follow-up period in the patients with PAF was consistently observed (non-OAC users: hazard ratio, 0.45; 95% confidence intervals, 0.27-0.75; P<0.01 and OAC users: hazard ratio, 0.59; 95% confidence interval, 0.35-0.93; P=0.03). The composite end point of stroke/systemic embolism/all-cause mortality was also lower in PAF, whether among OAC users (hazard ratio, 0.77; 95% confidence interval, 0.59-0.99; P=0.046) or non-OAC users (hazard ratio, 0.59; 95% confidence interval, 0.46-0.75; P<0.01). On multivariate analysis, PAF was an independent predictor of lower stroke/systemic embolism risk. Conclusions-In this large cohort of Japanese patients with AF, PAF was independently associated with lower incidence of stroke/systemic embolism than sustained AF. This may aid decision making for anticoagulation, especially in those patients with AF with few stroke risk factors. Clinical Trial Registration

AimsOver the last decade, major developments in medicine have led to significant changes in the clinical management of heart failure patients. This study was designed to evaluate the recent trends in clinical characteristics, management, and short‐term and long‐term prognosis of patients with acute decompensated heart failure (ADHF) in Japan.Methods and resultsThe Kyoto Congestive Heart Failure study is a prospective, observational, multicentre cohort study, enrolling consecutive ADHF patients from 19 participating hospitals in Japan from November 2014 to March 2016. A total of 4000 patients will be enrolled into the study and patients' anthropometric, socio‐economic, and clinical data from hospital admission to discharge will be collected. In addition, in a pre‐determined subgroup of patients (n=1500), a longitudinal follow‐up for 2 years is scheduled.ConclusionsThe Kyoto Congestive Heart Failure study will provide valuable information regarding patients with ADHF in the real‐world clinical practice of Japan and will be indispensable for future clinical and policy decision‐making with respect to heart failure.

Background and Purpose— Atrial fibrillation (AF) is a common arrhythmic disorder among the elderly and sometimes progresses from paroxysmal to sustained (persistent or permanent) types. Clinical outcomes of patients with progression of AF were unknown. This study assessed the characteristics of patients with AF progression and the impact of AF progression on various clinical events. Methods— The Fushimi AF Registry is a community-based prospective survey of the patients with AF in Fushimi-ku, Kyoto. Analyses were performed on 4045 patients, which included 1974 paroxysmal AF (PAF; 48.8%) and 2071 sustained (persistent or permanent) AF (SAF; 51.2%) at baseline. Results— During the median follow-up period of 1105 days, progression of AF occurred in 252 patients with PAF (4.22 per 100 person-years). Multivariate Cox regression analysis demonstrated that progression of AF was significantly associated with an increased risk of ischemic stroke or systemic embolism (adjusted hazard ratio [HR], 4.10; 95% CI, 1.95–8.24; P <0.001 [versus PAF without progression]; adjusted HR, 2.20; 95% CI, 1.11–4.00; P =0.025 [versus SAF]) during progression period from paroxysmal to sustained forms. The risk after the progression was equivalent to SAF (adjusted HR, 1.54; 95% CI, 0.78–2.75; P =0.201 [versus SAF]). AF progression was significantly associated with a higher risk of hospitalization for heart failure (adjusted HR, 2.70; 95% CI, 1.55–4.52; P <0.001 [versus PAF without progression]; adjusted HR, 1.81; 95% CI, 1.08–2.88; P =0.026 [versus SAF]). Conclusions— Progression of AF was associated with increased risk of clinical adverse events during arrhythmia progression period from PAF to SAF among Japanese patients with AF. The risk of adverse events was transiently elevated during progression period from PAF to SAF and declined to the level equivalent to SAF after the progression. Clinical Trial Registration— URL: http://www.umin.ac.jp/ctr/ . Unique identifier: UMIN000005834.