The AFLETES study: AF burden and risk in veteran athletes

By Dr Jonathan Shurlock
Edited by Dr Ahmed El-Medany

It is well understood that endurance athletes are at increased risk of atrial fibrillation (AF) when compared with the general population. The burden and risks of AF in this context however is less established. Dr Pallikadavath and team have attempted to begin to explore this area, with a survey based study of veteran endurance athletes.

Inclusion criteria included age of 40 and above and competing in at least 1 competitive endurance event. Additional collected information included demographic data, medical history, and training history.The authors calculated respondents’ CHA2DS2-VASc score from self-reported data.

1,002 responses were received from 41 countries, and 942 were included in the full analysis. 84% of respondents were male, with a mean age of 52.4 years (± 8.5 years). The most common sports for respondents to be actively involved in were cycling (n = 677, 72%) and running (n = 558, 59%). 190 respondents reported presence of AF (20%), while 26 reported a history of stroke (3%). Of those who reported a history of stroke, 15 (54%) also reported AF.

The authors found an association between lifetime exercise dose and AF, independent of additional risk factors (OR 1.02, 95% CI 1.00-1.03, P = 0.02). An association between swimming and AF was also seen (OR 1.56, 95% CI 1.02-2.39, P = 0.04). Unsurprisingly an association was also seen between presence of AF and stroke (OR 4.18, 95% CI 1.80-9.72, P < 0.01). Interestingly however this association persisted even in the presence of a low CHA2DS2-VASc score (OR 4.20, 95% CI 1.83-9.66, P < 0.01).

The authors suggest that their findings demonstrate a non-negligible risk of stroke in the context of AF in veteran athletes. They acknowledge the difficulty in effectively assessing stroke risk in such patients, and the impact this has on anticoagulation prescribing. The same group plan to further explore this area by utilising CMR, in work that is being supported by the BHF.

The full study can be found in the Clinical Journal of Sport Medicine here: