{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:24:02Z","timestamp":1792686242336,"version":"4.5.0"},"reference-count":28,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,8,30]]},"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>We compared long-term outcomes in patients with atrial fibrillation (AF) with and without a secondary precipitant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and setting<\/jats:title><jats:p>Retrospective cohort study based on Danish nationwide registries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Patients with AF with and without secondary precipitants (1996\u20132015) were matched 1:1 according to age, sex, calendar year, CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VASc score and oral anticoagulation therapy (OAC), resulting in a cohort of 39 723 patients with AF with a secondary precipitant and the same number of patients with AF without a secondary precipitant. Secondary precipitants included alcohol intoxication, thyrotoxicosis, myocardial infarction, surgery and infection in conjunction with AF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Primary and secondary outcomes<\/jats:title><jats:p>The primary outcome in this study was thromboembolic events. Secondary outcomes included AF rehospitalisation and death. Long-term risks of outcomes were examined by multivariable Cox regression analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The most common precipitants were infection (55.0%), surgery (13.2%) and myocardial infarction (12.0%). The 5-year absolute risk of thromboembolic events (taking death into account as a competing risk) in patients with AF grouped according to secondary precipitants were 8.3% (alcohol intoxication), 8.5% (thyrotoxicosis), 12.1% (myocardial infarction), 11.6% (surgery), 12.2% (infection), 10.1% (&gt;1 precipitant) and 12.3% (no secondary precipitant). In the multivariable analyses, AF with a secondary precipitant was associated with the same or an even higher thromboembolic risk than AF without a secondary precipitant. One exception was patients with AF and thyrotoxicosis: those not initiated on OAC therapy carried a lower thromboembolic risk the first year of follow-up than matched patients with AF without a secondary precipitant and no OAC therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In general, AF with a secondary precipitant was associated with the same thromboembolic risk as AF without a secondary precipitant. Consequently, this study highlights the need for more research regarding the long-term management of patients with AF associated with a secondary precipitant.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2018-028468","type":"journal-article","created":{"date-parts":[[2019,9,21]],"date-time":"2019-09-21T11:05:11Z","timestamp":1569063911000},"page":"e028468","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["Comparative thromboembolic risk in atrial fibrillation with and without a secondary precipitant\u2014Danish nationwide cohort study"],"prefix":"10.1136","volume":"9","author":[{"given":"A","family":"Gundlund","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"K\u00fcmler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders Nissen","family":"Bonde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jawad Haider","family":"Butt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunnar Hilmar","family":"Gislason","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Torp-Pedersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"K\u00f8ber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas Bjerring","family":"Olesen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emil Loldrup","family":"Fosb\u00f8l","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,9,20]]},"reference":[{"key":"2024052012471511000_9.9.e028468.1","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1016\/j.hrthm.2015.12.010","article-title":"New-onset atrial fibrillation and thromboembolic risk: cardiovascular syzygy?","volume":"13","author":"Procter","year":"2016","journal-title":"Heart Rhythm"},{"key":"2024052012471511000_9.9.e028468.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318214876d"},{"key":"2024052012471511000_9.9.e028468.3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.4369"},{"key":"2024052012471511000_9.9.e028468.4","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw210"},{"key":"2024052012471511000_9.9.e028468.5","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000041"},{"key":"2024052012471511000_9.9.e028468.6","doi-asserted-by":"publisher","DOI":"10.1177\/1403494810387965"},{"key":"2024052012471511000_9.9.e028468.7","doi-asserted-by":"publisher","DOI":"10.1177\/1403494811401482"},{"key":"2024052012471511000_9.9.e028468.8","doi-asserted-by":"publisher","DOI":"10.1177\/1403494811399958"},{"key":"2024052012471511000_9.9.e028468.9","doi-asserted-by":"publisher","DOI":"10.1177\/1403494810394717"},{"key":"2024052012471511000_9.9.e028468.10","unstructured":"Locally Written SAS Macros - Division of Biomedical Statistics and Informatics - Mayo Clinic Research [Internet]. 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