Atrial Fibrillation: Age at Diagnosis, Incident Cardiovascular Events, and Mortality
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND AND AIMS
Patients with atrial fibrillation (AF) are at increased risks of cardiovascular diseases and mortality, but risks according to age at diagnosis have not been reported. This study investigated age-specific risks of outcomes among patients with AF and the background population.
METHODS
This nationwide population-based cohort study included patients with AF and controls without outcomes by the application of exposure density matching on the basis of sex, year of birth, and index date. The absolute risks and hazard rates were stratified by age groups and assessed using competing risk survival analyses and Cox regression models, respectively. The expected differences in residual life years among participants were estimated.
RESULTS
The study included 216 579 AF patients from year 2000 to 2020 and 866 316 controls. The mean follow-up time was 7.9 years. Comparing AF patients with matched controls, the hazard ratios among individuals ≤50 years was 8.90 [95% confidence interval (CI), 7.17-11.0] for cardiomyopathy, 8.64 (95% CI, 7.74-9.64) for heart failure, 2.18 (95% CI, 1.89-2.52) for ischaemic stroke, and 2.74 (95% CI, 2.53-2.96) for mortality. The expected average loss of life years among individuals ≤50 years was 9.2 years (95% CI, 9.0-9.3) years. The estimates decreased with older age.
CONCLUSIONS
The findings show that earlier diagnosis of AF is associated with a higher hazard ratio of subsequent myocardial disease and shorter life expectancy. Further studies are needed to determine causality and whether AF could be used as a risk marker among particularly younger patients.
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Additional Info
Atrial fibrillation: age at diagnosis, incident cardiovascular events, and mortality
Eur Heart J 2024 Apr 09;[EPub Ahead of Print], C Paludan-Müller, OB Vad, NK Stampe, SZ Diederichsen, L Andreasen, LM Monfort, EL Fosbøl, L Køber, C Torp-Pedersen, JH Svendsen, MS OlesenFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
For the last 5 years or so, there has been an increased focus on cardiomyopathy and heart failure among patients with atrial fibrillation (AF), supported by a genetic component particularly among those with early-onset AF (age ≤65 years), which might explain a portion of these well-known associations.1-5 Although AF is well-known as the initial manifestation of later myocardial disease,6 the risks of subsequent cardiomyopathy, heart failure, and mortality among patients with AF in accordance with age have not previously been reported; this nationwide population-based cohort study provides novel information on the topic.
The present study involved 216,579 patients diagnosed with AF and 866,316 matched controls between 2000 and 2020. The authors analyzed the absolute risks and rates of outcomes according to age and estimated the expected differences in residual life-years. In summary, comparing the patients with controls, the study observed a stepwise pattern for cardiomyopathy, heart failure, and mortality, with a higher rate increase at earlier diagnosis. Younger age was especially associated with increased rates of myocardial disease and a large reduction in expected average life-years.
The most noteworthy hazard ratios for the investigated outcomes when comparing patients with AF aged ≤50 and >80 years with matched controls were as follows: cardiomyopathy ranged from 8.90 (95% CI, 7.17–11.0) to 2.90 (95% CI, 2.46–3.42), heart failure ranged from 8.64 (95% CI, 7.74–9.64) to 4.11 (95% CI, 3.99–4.24), and mortality ranged from 2.74 (95% CI, 2.53–2.96) to 2.29 (95% CI, 2.26–2.32). The expected average loss of residual life-years between patients and controls varied from 11.3 years (95% CI, 11.0–11.6) among individuals aged ≤30 years to 3.6 years (95% CI, 3.5–3.6) among individuals aged ≤80 years at the time of diagnosis.
At a time when the knowledge of AF among younger patients is steadily improving, it is important that continued research is performed to understand if there is a causal relationship and whether AF could be used as an early indication (eg, a red flag or risk marker) of future ventricular myocardial disease. It should be further investigated to which degree these associations could be caused by the arrhythmia per se or by shared underlying risk factors, including a genetic component. Causality should be determined as the mechanisms for disease progression among patients may be different in accordance with age. Since there is an effort to improve risk stratification for AF itself,7,8 this study could stimulate interest among colleagues to improve the prediction of AF complications as well. The development of better prediction models for arrhythmia complications is especially relevant, considering that the newest US guidelines from November provide a weak recommendation for genetic testing among patients with AF onset before 45 years of age.9
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