What is the clinical evidence from this study?

Study design: Cohort. Population: Incident atrial fibrillation (n=9895). Intervention: Poor self-rated health vs. Good self-rated health. Primary outcome: Incident atrial fibrillation (HR 1.85, 95% CI 1.19-2.87, p=0.01).

October 20, 2024Open Access

Self-rated health and the risk of incident atrial fibrillation in general population

Key Result

Poor self-rated health was independently associated with a higher risk of incident atrial fibrillation compared to good self-rated health (adjusted HR 1.85) over a median follow-up of 11 years.

Study Design

Type

Cohort (n=9,895)

Multicenter

Yes

Structured PICO

Does poor self-rated health predict incident atrial fibrillation in the general population?

Population

9,895 adults aged 40-69 years from a community-based Korean cohort, free of baseline atrial fibrillation, followed for a median of 11 years.

Exposure

Poor self-rated health (SRH)

Comparator

Good self-rated health (SRH)

Outcome

Incident atrial fibrillation (identified through biennial 12-lead electrocardiography and/or self-reported history of physician-determined diagnoses)hard clinical

Poor self-rated health is independently associated with a higher risk of developing incident atrial fibrillation in the general population, though it adds only marginal predictive value to conventional risk factors.

Main Result

Hazard Ratio: 1.85 (95% CI 1.19–2.87)

Absolute Event Rate: 1.9% vs 1.2%

p-value: p=0.01

Limitations

Observational design precludes establishing a causal relationship due to potential unmeasured confounding.
Relatively low incidence of AF compared to other cohorts, possibly indicating under-recognition.
Use of biennial 12-lead ECG and self-reported physician diagnosis could result in under-recognition of paroxysmal AF.
Self-rated health was measured only once at baseline and may have varied over time.
Competing risk of death was not accounted for using competing risk models.

Abstract

The association between self-rated health (SRH) and the development of atrial fibrillation (AF) in the general population remains underexplored. We reviewed the data of 9,895 participants in the Ansung-Ansan cohort study, a community-based Korean study. SRH was categorised as 'poor', 'fair', or 'good'. A newly developed AF was identified through biennial electrocardiography examinations and/or a self-reported history of physician-determined diagnoses. Over a median follow-up of 11 years, 149 patients (1.5%) developed AF. Compared with the 'good' group, the 'poor' group exhibited a higher risk of incident AF (adjusted hazard ratio, 1.85; 95% confidence interval, 1.19-2.87). Old age, female sex, lower educational level, smoking, cardiovascular diseases (hypertension, diabetes mellitus, and coronary artery disease), and inflammation were associated with 'poor' SRH. Along with SRH, age, male sex, urban residence, hypertension, and myocardial infarction were also associated with a higher risk of incidental AF. The combined model, which included conventional risk factors and SRH, demonstrated a marginally improved performance in predicting incident AF (concordance index: 0.704 vs. 0.714, P = 0.058). Poor SRH is independently associated with the development of AF in Korean adults. However, it plays a limited role in AF surveillance when combined with conventional AF risk factors.

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