Atrial fibrillation risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sem A.O.F. Rikken, M.D.[2]
Overview
Atrial fibrillation (AF) is influenced by a range of modifiable and non-modifiable risk factors. Modifiable risk factors include lifestyle and medical conditions such as excessive Alcohol consumption, Tobacco use, Caffeine, stimulant abuse (e.g., Cocaine abuse). Addressing Hypertension, Diabetes mellitus, Obesity, and Physical inactivity are essential as these conditions significantly contribute to AF development. Moreover, reversible conditions like Obstructive sleep apnea have also been recognized as targets for risk reduction strategies to limit AF recurrence and progression.
Non-modifiable or less reversible factors include structural cardiac abnormalities such as Hypertrophic Obstructive Cardiomyopathy, Chronic heart failure, advanced Chronic kidney diseasee, and a positive familial history of Atrial fibrillation. Other important comorbidities that exacerbate AF risk and complications include Valvular heart disease prior Myocardial infarction and Thyroid disorders.
Risk factors linked to systemic embolization or ischemic stroke in patients with non-valvular AF include Advanced age, Male sex, impaired left Systolic dysfunction impaired, Diabetes mellitus, and Hypertension. The European Society of Cardiology guidelines emphasize the role of these factors in thromboembolic risk stratification, particularly when assessing candidates for oral anticoagulation therapy.[1]
Additionally, specific settings such as post-cardiac or thoracic surgery and the use of diuretics have been identified as potential triggers for new-onset AF. Notably, sleep apnea management and weight reduction in obese individuals are now integral components of AF care, with evidence suggesting reductions in AF recurrence and symptom burden.
In practice, the "AF-CARE" framework integrates the management of comorbidities (e.g., obesity, hypertension) alongside anticoagulation and rhythm control strategies to improve outcomes, reduce AF burden, and prevent complications such as stroke. Early and individualized management remains a cornerstone of AF care to adapt to the dynamic nature of the condition and its associated risks.[1]
Risk Factors
Reversible or Modifiable Underlying Conditions Associated with Atrial Fibrillation
- Alcohol and alcohol withdrawal
- Breath spray which contains alcohol [2]
- Caffeine (coffee or tea)
- Cocaine
- Smoking[3][4]
- Coronary artery bypass graft surgery
- Esophageal surgery [3]
- Hyperthyroidism
- Hypertension[4]
- Diabetes [4]
- Obesity [4]
- Hypomagnesemia[5]
- Hypothermia
- Hypothyroidism
- Hypoxia
- Pericarditis and pericardial disease in general
- Pheochromocytoma
- Pulmonary embolism
- Stimulants
- Sedentary lifestyle [4]
- Sleep apnea [4]
Irreversible Underlying Conditions Associated with Atrial Fibrillation
- Hypertrophic Obstructive Cardiomyopathy [3]
- Heart failure[6]
- Short QT syndrome
- Chronic renal failure[7]
- Ischemia heart disease[3]
- Familial history [8]
Risk Stratification
- Once a patient develops atrial fibrillation, their risk of subsequent events can be assessed using the following scores:
- The risk of bleeding associated with anticoagulation can be assessed using the following score:
Risk factors for Ischemic Stroke or Systemic Embolization in Patients with Non-valvular Atrial Fibrillation
Risk factors and relative risks are tabulated below: [9][10][3]
| Risk Factor | Relative Risk |
| Advanced age (continuous, per decade) | |
| History of hypertension | |
| Heart failure or impaired left ventricular systolic function | |
| Coronary artery disease (CAD) | |
| Diabetes mellitus (DM) | |
| Previous stroke or Transient Ischemic Attack (TIA) |
Other Risk Factors
Reference
- ↑ 1.0 1.1 Van Gelder, Isabelle C.; Rienstra, Michiel; Bunting, Karina V.; Casado-Arroyo, Ruben; Caso, Valeria; Crijns, Harry J G M; De Potter, Tom J R; Dwight, Jeremy; Guasti, Luigina; Hanke, Thorsten; Jaarsma, Tiny; Lettino, Maddalena; Løchen, Maja-Lisa; Lumbers, R Thomas; Maesen, Bart; Mølgaard, Inge; Rosano, Giuseppe M C; Sanders, Prashanthan; Schnabel, Renate B; Suwalski, Piotr; Svennberg, Emma; Tamargo, Juan; Tica, Otilia; Traykov, Vassil; Tzeis, Stylianos; Kotecha, Dipak (2024). "2024 ESC Guidelines for the Management of Atrial Fibrillation". European Heart Journal. 45 (36): 3314–3403. doi:10.1093/eurheartj/ehaa612.
- ↑ Ridker PM, Gibson CM, Lopez R (1989). "Atrial fibrillation induced by breath spray". N Engl J Med. 320 (2): 124. PMID 2914028.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ; et al. (2001). "Pathophysiology and prevention of atrial fibrillation". Circulation. 103 (5): 769–77. doi:10.1161/01.cir.103.5.769. PMID 11156892.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH (2017). "Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes". Circ Res. 120 (9): 1501–1517. doi:10.1161/CIRCRESAHA.117.309732. PMC 5500874. PMID 28450367.
- ↑ May Khan A, Lubitz SA, Sullivan LM, Sun JX, Levy D, Vasan RS; et al. (2012). "Low Serum Magnesium and the Development of Atrial Fibrillation in the Community: The Framingham Heart Study". Circulation. doi:10.1161/CIRCULATIONAHA.111.082511. PMID 23172839.
- ↑ Chamberlain AM, Redfield MM, Alonso A, Weston SA, Roger VL (2011). "Atrial fibrillation and mortality in heart failure: a community study". Circ Heart Fail. 4 (6): 740–6. doi:10.1161/CIRCHEARTFAILURE.111.962688. PMC 3222889. PMID 21920917.
- ↑ McManus DD, Rienstra M, Benjamin EJ (2012). "An update on the prognosis of patients with atrial fibrillation". Circulation. 126 (10): e143–6. doi:10.1161/CIRCULATIONAHA.112.129759. PMC 3678907. PMID 22949543.
- ↑ Lubitz SA, Ozcan C, Magnani JW, Kääb S, Benjamin EJ, Ellinor PT (2010). "Genetics of atrial fibrillation: implications for future research directions and personalized medicine". Circ Arrhythm Electrophysiol. 3 (3): 291–9. doi:10.1161/CIRCEP.110.942441. PMC 3062900. PMID 20551423.
- ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199
- ↑ Nieuwlaat R, Prins MH, Le Heuzey JY, Vardas PE, Aliot E, Santini M; et al. (2008). "Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on atrial fibrillation". Eur Heart J. 29 (9): 1181–9. doi:10.1093/eurheartj/ehn139. PMID 18397874.