Outcomes in AF Patients With and Without Diabetes

Study Questions:

What is the association of diabetes and outcomes of atrial fibrillation (AF)?

Methods:

The investigators included 9,749 patients from the ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry, a prospective, nationwide, outpatient registry of patients with incident and prevalent AF. Outcomes included symptoms, health status, and AF treatment, as well as 2-year risk of death, hospitalization, thromboembolic events, heart failure (HF), and AF progression. A logistic regression model was used to estimate the odds ratio (OR) for the association between diabetes and AF progression.

Results:

Patients with diabetes (29.5%) were younger, and more likely to have hypertension, chronic kidney disease, HF, coronary heart disease, and stroke. Compared to patients without diabetes, patients with diabetes also had a lower Atrial Fibrillation Effects on Quality of Life score of 80 (interquartile range [IQR], 62.5-92.6) vs. 82.4 [IQR, 67.6-93.5; p = 0.025) and were more likely to receive anticoagulation (p < 0.001). Diabetes was associated with higher mortality risk, including overall (adjusted hazard ratio [aHR], 1.63; 95% confidence intervals [CI], 1.04-2.56 for age <70 years vs. aHR, 1.25; 95% CI, 1.09-1.44 for age ≥70 years) and cardiovascular (CV) mortality (aHR, 2.20; 95% CI, 1.22-3.98 for age <70 years vs. 1.24; 95% CI, 1.02-1.51 for age ≥70 years). Diabetes conferred a higher risk of non-CV death, sudden cardiac death, hospitalization, CV hospitalization, and non-CV and nonbleeding-related hospitalization, but no increase in risks of thromboembolic events, bleeding-related hospitalization, new-onset HF, and AF progression.

Conclusions:

The authors concluded that among AF patients, diabetes was associated with worse AF symptoms and lower quality of life, and increased risk of death and hospitalizations, but not thromboembolic or bleeding events.

Perspective:

This cohort study reports that patients with AF and diabetes had more symptoms and worse health status along with a higher mortality and higher frequency of hospitalization than patients without diabetes. Furthermore, even after extensive covariate adjustment, diabetes was independently associated with an increased risk of all-cause and CV mortality in community-based patients with AF. Additional studies are warranted to explore ways to ameliorate this growing problem, which may worsen in the years to come given the evolving diabetes epidemic.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Hypertension

Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Coronary Disease, Death, Sudden, Cardiac, Diabetes Mellitus, Heart Failure, Hemorrhage, Hospitalization, Hypertension, Metabolic Syndrome X, Outcome Assessment (Health Care), Quality of Life, Renal Insufficiency, Chronic, Secondary Prevention, Stroke, Thromboembolism


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