Patients with atrial fibrillation (AFib) and diabetes have worse AFib symptoms, lower quality of life, higher mortality and higher hospitalization rates than AFib patients without diabetes, according to a study recently published in the Journal of the American College of Cardiology.

Justin B. Echouffo-Tcheugui, MD, PhD, et al., enrolled 9,479 adults with AFib from the ORBIT-AF registry for this prospective, observational cohort study with a mean follow-up of 2.4 years. Diabetes was diagnosed in 2,874 of the AFib patients (29.5 percent).

Patients with diabetes versus those without had a higher risk of stroke (p < 0.001) and bleeding (p < 0.001). Patients with diabetes had greater functional impairment, more dyspnea, more fatigue and lower overall median Atrial Fibrillation Effect on Quality of Life scores. Patients with diabetes used more anticoagulants than those without diabetes.

Patients with diabetes had higher rates of cardiovascular death, non-cardiovascular death and sudden cardiac death (SCD). Multivariate analysis showed that diabetes was associated with a higher risk of all-cause death, both among patients <70 years (adjusted hazard ratio [HR], 1.63; p = 0.033) and those ≥70 years of age (adjusted HR, 1.25; p = 0.001). On multivariate analysis, diabetes was also associated with a significantly increased risk of cardiovascular death, non-cardiovascular death, SCD, all-cause and cardiovascular hospitalization, and non-cardiovascular, non-bleeding hospitalization.

Patients with diabetes did not have an increased risk of thromboembolic events, AFib progression or incident heart failure.

“Among patients with AFib in this nationwide cohort, the prevalence of diabetes mellitus was 30 percent, emphasizing the importance of diabetes screening in patients diagnosed with AFib,” the authors write. “Future studies are warranted to explore ways to mitigate this mounting problem, which could exponentially worsen in the years to come given the growing diabetes epidemic,” the authors conclude.

Zachary T. Bloomgarden, MD, et al., commented in an editorial that some of the findings “offer grounds for optimism.” The observation that patients with diabetes were more likely to receive anticoagulation may explain why there were no differences in thromboembolic events. The absence of bleeding complications in patients with diabetes suggests a favorable benefit-to-risk balance with anticoagulation therapy. 

“The study offers perhaps the most comprehensive assessment of the management and outcomes of patients with concomitant diabetes and AFib to date, increases our understanding of the cardiovascular consequences of diabetes, and may influence our approach to the diabetic patient who develops AFib,” they write.

Keywords: United States, Atrial Fibrillation, Anticoagulants, Prevalence, Multivariate Analysis, Prospective Studies, Follow-Up Studies, Quality of Life, Thromboembolism, Stroke, Heart Failure, Hemorrhage, Registries, Diabetes Mellitus, Hospitalization, Death, Sudden, Cardiac, Dyspnea

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