Stelios Karayiannides1,2, Pia Lundman1,3, Leif Friberg1, Anna Norhammar4,5. 1. 1 Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden. 2. 2 Department of Internal Medicine, Danderyd University Hospital, Stockholm, Sweden. 3. 3 Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden. 4. 4 Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 5. 5 Department of Clinical Physiology, Capio St Görans Hospital, Stockholm, Sweden.
Abstract
AIM: To describe nationwide complication patterns in patients with atrial fibrillation and diabetes mellitus. METHODS: All ( n = 326,832) patients in Sweden with non-valvular atrial fibrillation during 2006-2012 were identified, and information on events, comorbidities and pharmacological therapy was extracted using nationwide mandatory registers. Patients were followed until 31 December 2013 and the mean follow-up time was 3.7 years (0.9-8 years). RESULTS: Diabetes was present in 17.7%. The most frequent events in those with and without diabetes were mortality (48.8% vs 36.4%; p < 0.001), heart failure (21.4% vs 13.1%; p < 0.001), ischaemic stroke (8.2% vs 6.8%; p < 0.001), myocardial infarction (7.3% vs 4.3%; p < 0.001) and any bleeding (6.3% vs 5.2%; p < 0.001), respectively. Diabetes predicted mortality (hazard ratio = 1.28; 95% confidence interval = 1.25-1.31), combined event (first of mortality, heart failure, ischaemic stroke or myocardial infarction; hazard ratio = 1.22; 95% confidence interval = 1.20-1.25), single events and bleeding (hazard ratio = 1.12; 95% confidence interval = 1.06-1.19). The standardised mortality ratio for patients with atrial fibrillation and diabetes compared to the general population was 2.06 (95% confidence interval = 2.00-2.12) and for patients with atrial fibrillation without diabetes was 1.33 (95% confidence interval = 1.31-1.35). CONCLUSION: In this real-world setting, patients with atrial fibrillation and diabetes have a high cardiovascular risk, with mortality and heart failure rates exceeding those for stroke.
AIM: To describe nationwide complication patterns in patients with atrial fibrillation and diabetes mellitus. METHODS: All ( n = 326,832) patients in Sweden with non-valvular atrial fibrillation during 2006-2012 were identified, and information on events, comorbidities and pharmacological therapy was extracted using nationwide mandatory registers. Patients were followed until 31 December 2013 and the mean follow-up time was 3.7 years (0.9-8 years). RESULTS:Diabetes was present in 17.7%. The most frequent events in those with and without diabetes were mortality (48.8% vs 36.4%; p < 0.001), heart failure (21.4% vs 13.1%; p < 0.001), ischaemic stroke (8.2% vs 6.8%; p < 0.001), myocardial infarction (7.3% vs 4.3%; p < 0.001) and any bleeding (6.3% vs 5.2%; p < 0.001), respectively. Diabetes predicted mortality (hazard ratio = 1.28; 95% confidence interval = 1.25-1.31), combined event (first of mortality, heart failure, ischaemic stroke or myocardial infarction; hazard ratio = 1.22; 95% confidence interval = 1.20-1.25), single events and bleeding (hazard ratio = 1.12; 95% confidence interval = 1.06-1.19). The standardised mortality ratio for patients with atrial fibrillation and diabetes compared to the general population was 2.06 (95% confidence interval = 2.00-2.12) and for patients with atrial fibrillation without diabetes was 1.33 (95% confidence interval = 1.31-1.35). CONCLUSION: In this real-world setting, patients with atrial fibrillation and diabetes have a high cardiovascular risk, with mortality and heart failure rates exceeding those for stroke.
Authors: Salva R Yurista; Herman H W Silljé; Michiel Rienstra; Rudolf A de Boer; B Daan Westenbrink Journal: Cardiovasc Diabetol Date: 2020-01-07 Impact factor: 9.951