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Background  Atrial flutter ( AFL ) has been identified to be equivalent to atrial fibrillation ( AF ) in terms of preventing ischemic stroke, although differences exist in atrial rate, substrate, and electrophysiological mechanisms. This study aimed to investigate differences in clinical outcomes between nonvalvular  AF  and  AFL .    Methods and Results   AF  and  AFL  patients without any prescribed anticoagulation were enrolled from a 13‐year national cohort database. Under series exclusion criteria, ischemic stroke, heart failure hospitalization, and all‐cause mortality were compared between the groups in real‐world conditions and after propensity score matching. We identified 175 420 patients in the  AF  cohort and 6239 patients in the  AFL  cohort, and the prevalence of most comorbidities and frequency of medications were significantly higher in the  AF  group than the  AFL  group. In the real‐world setting the  AF  patients had higher incidence rates of ischemic stroke, heart failure hospitalization, and all‐cause mortality than the  AFL  patients (all  P <0.001). After propensity score matching, the incidence rate of ischemic stroke in the  AF  cohort was 1.63‐fold higher than in the  AFL  cohort ( P <0.001), the incidence rate of heart failure hospitalization in the  AF  cohort was 1.70‐fold higher than in the  AFL  cohort ( P <0.001), and the incidence rate of all‐cause mortality in the  AF  cohort was 1.08‐fold higher than in the  AFL  cohort ( P =0.002).    Conclusions  There were differences between  AF  and  AFL  in comorbidities and prognosis with regard to ischemic stroke, heart failure hospitalization, and all‐cause mortality.

journal of the american heart association

Different Implications of Heart Failure, Ischemic Stroke, and Mortality Between Nonvalvular Atrial Fibrillation and Atrial Flutter—a View From a National Cohort Study