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The effect of body mass index on clinical outcomes in patients with newly diagnosed atrial fibrillation in the GARFIELD-AF registry

Session Atrial Fibrillation-Related Stroke: the Features Worth Clinician’s Attention

Event : ESC Congress 2020

  • Topic : arrhythmias and device therapy
  • Sub-topic : Epidemiology, Prognosis, Outcome
  • Session type : Best ePosters

Authors : CJF Camm (Oxford,GB), A J Camm (London,GB), S Virdone (London,GB), J-P Bassand (Besançon,FR), DA Fitzmaurice (Coventry,GB), KAA Fox (Edinburgh,GB), SZ Goldhaber (Boston,US), S Goto (Kanagawa,JP), S Haas (Munich,DE), AGG Turpie (Hamilton,CA), FWA Verheugt (Amsterdam,NL), F Misselwitz (Berlin,DE), G Kayani (London,GB), KS Pieper (London,GB), A K Kakkar (London,GB)

CJF Camm1 , A J Camm2 , S Virdone3 , J-P Bassand4 , DA Fitzmaurice5 , KAA Fox6 , SZ Goldhaber7 , S Goto8 , S Haas9 , AGG Turpie10 , FWA Verheugt11 , F Misselwitz12 , G Kayani3 , KS Pieper3 , A K Kakkar13 , 1University of Oxford - Oxford - United Kingdom of Great Britain & Northern Ireland , 2St George's University of London, Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, - London - United Kingdom of Great Britain & Northern Ireland , 3Thrombosis Research Institute - London - United Kingdom of Great Britain & Northern Ireland , 4Thrombosis Research Institute, London, UK and University of Besançon - Besançon - France , 5University of Warwick - Coventry - United Kingdom of Great Britain & Northern Ireland , 6University of Edinburgh - Edinburgh - United Kingdom of Great Britain & Northern Ireland , 7Brigham And Women'S Hospital, Harvard Medical School - Boston - United States of America , 8Tokai University School of Medicine - Kanagawa - Japan , 9Technical University of Munich, Formerly Department of Medicine - Munich - Germany , 10McMaster University - Hamilton - Canada , 11Onze Lieve Vrouwe Gasthuis (OLVG) - Amsterdam - Netherlands (The) , 12Bayer AG - Berlin - Germany , 13Thrombosis Research Institute and University College London - London - United Kingdom of Great Britain & Northern Ireland ,

On behalf: GARFIELD-AF Investigators

Atrial Fibrillation - Epidemiology, Prognosis, Outcome

Introduction: Higher body mass index (BMI) is associated with a higher risk of atrial fibrillation (AF). However, previous evidence has suggested an inverse association between BMI and risk of AF outcomes.

Purpose: To explore the association between BMI and outcomes in those with newly diagnosed AF in the GARFIELD-AF registry.

Methods: GARFIELD-AF is an international registry of consecutively recruited patients aged =18 years with newly diagnosed AF and =1 stroke risk factor. Data were collected prospectively on 52,080 patients. Participants with missing or extreme BMI values and those without two-year follow-up were excluded. Cox proportional hazard models were used to estimate the effect of BMI on the risk of outcomes. Models were adjusted for age, sex, ethnicity, smoking, alcohol, and =moderate chronic kidney disease. Where appropriate participants were divided into groups based on BMI. Restricted cubic splines were used to assess non-linear relationships.

Results: BMI and outcome data were available for 40,495 patients. Those with higher BMI were generally younger, and more likely to have pre-existing hypertension, diabetes, or vascular disease (Table). Underweight patients received anticoagulation less often than those in other groups (60.3% vs 67.9%, respectively). During follow-up, 2,801 participants (6.9%) died and 603 (1.5%) had new/worsening heart failure.  Following adjustment for potential confounders, a U-shaped relationship was seen between BMI and all-cause mortality and new/worsening heart failure (Figure). For all-cause mortality, the lowest risk was at 30kg/m². Below this level, there was an 8% higher risk of mortality (95% confidence interval (CI) 6 to 9%) per 1kg/m² lower BMI. Above 30kg/m², there was a 5% higher risk of mortality per 1kg/m² higher BMI (95% CI 4 to 7%). For new/worsening heart failure, the lowest risk was at 25kg/m². Above this level, 1kg/m² higher BMI was associated with an 5% higher risk (95% CI 13 to 6%).

Conclusions: BMI was an important risk factor for both all-cause mortality and new/worsening heart failure in AF. Those at both extremes of BMI are at higher risk.




(18.5 to <25kg/m²)


(25 to <30kg/m²)


(30 to <35kg/m²)

Very Obese


p value
Participants 703 13098 15050 7564 4080
Male, n(%) 275 (39.1) 7230 (55.2) 9281 (61.7) 4199 (55.5) 1907 (46.7) < 0.001
Age, median (IQR) 77 (68-84) 73 (64-80) 71 (62-78) 69 (61-76) 66 (59-73) < 0.001
Diabetes, n(%) 69 (9.8) 2099 (16.0) 3192 (21.2) 2240 (29.6) 1591 (38.9) < 0.001
Vascular Disease, n(%) 147 (21.0) 2961 (22.8) 3881 (25.9) 2182 (29.0) 1106 (27.3) < 0.001
Hypertension, n(%) 388 (55.2) 8946 (68.3) 11820 (78.5) 6494 (85.9) 3602 (88.3) < 0.001

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