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Background  The presence of valvular heart disease ( VHD ) may affect the risk of stroke and mortality in patients with atrial fibrillation ( AF ). Community‐based estimates of prevalence and outcomes of specific forms of  VHD  in patients with  AF  are lacking.    Methods and Results  We examined the prevalence of  VHD , anticoagulation use, mortality, stroke/transient ischemic attack, and bleeding among a community cohort of patients with  AF . Significant  VHD  was defined as follows: (1) moderate/severe mitral stenosis or mechanical valve; (2) bioprosthetic valve, surgical repair, or balloon valvuloplasty; and (3) moderate/severe aortic regurgitation or stenosis, mitral regurgitation, or tricuspid regurgitation. Proportional hazards models were performed to test the association between  VHD  groups and outcomes. Among 9748 patients with  AF , 2705 (27.7%) had significant  VHD . Anticoagulation use was highest among patients with mitral stenosis/mechanical valve (91.8%). Compared with individuals with no significant  VHD , individuals with aortic regurgitation/aortic stenosis, mitral regurgitation, or tricuspid regurgitation (hazard ratio, 1.23; 95% confidence interval, 1.07–1.42) had the highest risk of death. There were no differences in stroke or transient ischemic attack and major bleeding among individuals with and without significant  VHD . Patients with  AF  and aortic stenosis had the highest risk of death (hazard ratio, 1.32; 95% confidence interval, 1.08–1.62).    Conclusions  Significant  VHD  is common among patients with  AF  in community practice. In a community cohort of patients with  AF  and  CHA  2  DS  2 ‐ VAS c score ≥2, most were anticoagulated. Individuals with  AF  and moderate‐to‐severe biological  VHD  have more comorbidities and a higher mortality risk; however, stroke and major bleeding are similar among those with and without significant  VHD .

journal of the american heart association

Prevalence, Characteristics, and Outcomes of Valvular Heart Disease in Patients With Atrial Fibrillation: Insights From the ORBIT‐AF (Outcomes Registry for Better Informed Treatment for Atrial Fibrillation)