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1998 Presentations for the Poster and Vignette Sessions
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MORTALITY AND CLINICAL PREDICTORS OF DEATH IN NEWLY­DIAGNOSED ATRIAL FLUTTER: A STUDY IN THE GENERAL POPULATION FROM THE MARSHFIELD EPIDEMIOLOGIC STUDY AREA (MESA). Juan Granada, MD, Humberto Vidaillet Jr, MD, FACP, Robert Vierkant, MAS, William Uribe, MD, Armando Falcon MD, Frank DeStefano MD, Peter Smith, MD, John Hayes, MD, Elaine Eaker, ScD. Marshfield, WI.

Background: Other than Atrial Fibrillation, Atrial Flutter is the most common chronic tachyarrhythmia seen in general practice. Although Atrial Flutter is considered a common precursor to Atrial Fibrillation, there is little data to suggest that Atrial Flutter itself is a harbinger of poor prognosis. At this time, radiofrequency ablation is considered curative and anticoagulation is not recommended for most of these patients.

Objective: To determine the frequency, cause and clinical predictors of death among patients with newly diagnosed Atrial Flutter in the general population.

Methods: We used the resources of the Marshfield Epidemiologic Study Area (MESA), where the combined medical record system captures virtually all medical care received by its 55,000 residents. A review of the medical records of 1,989 potential cases identified all cases of newly diagnoses Atrial Flutter from 7/1/91 to 6/30/95.

Results: a total of 181 cases of newly diagnosed Atrial Flutter were identified. Their mean age was 72 years and 112 (62%) were males. At the time of initial diagnosis of Atrial Flutter, Atrial Fibrillation was also found in 136 patients (75%). During 3.5 years of follow up, 43% died at a mean interval of 23.2 months from the time of diagnosis. Among the 77 deaths, 48% were due to cardiac disease, 10% due to stroke and 42% due to other causes. From 12 pre­selected clinical variables, 10 were statistically significant in a univariate analysis. After adjusting for co­morbid conditions, independent predictors of death were age >80 years (RR 4.11, CI 95%, 1.95, 8.68): Atrial Flutter PLUS Atrial Fibrillation Status (RR 2.44, CI, 95%, 1.28, 4.76): COPD (RR 1.93, CI, 95%, 1.13, 3.29) and HTN (RR 1.63, CI 95%, 0.99, 2.70). Patients with all four of these risk factors were more than 30 times as likely to die than those without any of them.

Conclusions: 1) This study, the first population­based investigation of Atrial Flutter, challenges many existing beliefs regarding this common condition. 2) Our findings show that patients with Atrial flutter in the "real world" and the condition itself are different in the general population than in tertiary care centers. #) After adjustment, advancing age, concomitant Atrial Fibrillation, COPD and HTN were the strongest predictors of death. 4) Our data demonstrate the importance of population­based research and the need of further investigation on the epidemiology of common cardiac arrhythmias.

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