In patients with new-onset atrial fibrillation, 14.8% had a history of thyroid disease and 3.3% had a new diagnosis, with historical hyperthyroidism associated with the poorest two-year survival.
Cohort (n=122,859)
Yes
Does the presence and timing of hypo- or hyperthyroidism affect two-year mortality in patients with new-onset atrial fibrillation?
In a nationwide Finnish cohort of patients with new-onset AF, thyroid diseases were highly prevalent, and a history of hyperthyroidism was associated with the poorest two-year survival.
Abstract Introduction Hyperthyroidism is associated with atrial fibrillation (AF), while the link with hypothyroidism is less studied. However, nationwide studies including also laboratory data and investigating associations of thyroid diseases and AF are lacking. Purpose To study prevalences of hypo- and hyperthyroidism in patients with new-onset AF in Finland from 2011 to 2018. Old diagnoses – more than 3 months before the diagnosis of AF, and new diagnoses (± 3 months around the diagnosis of AF) were separately assessed. Furthermore, we evaluated the two-year mortality in these patient groups. Methods In the Finnish Anticoagulation in Atrial Fibrillation (FinACAF) study we gathered data on all patients with AF from all national health care registers (hospitalizations and outpatient specialist visits, primary health care contacts, and reimbursements for prescription medicines) from 2004 to 2018. Here, we included all patients ≥20 years with a new-onset non-valvular AF between 2011 and 2018 and with laboratory data available. The presence of a thyroid disease was based on a diagnosis in any of the national registers, or a patient had a laboratory value, or a medicine in use to indicate either hypo- or hyperthyroidism. We excluded those with missing laboratory data, radioactive iodine or amiodarone therapy before the cohort entry. We classified patients in five groups: 1) those with hyperthyroidism ±3 months of AF; 2) those with hypothyroidism ±3 months of AF; 3) those without thyroid diseases; 4) those with hyperthyroidism 3 months before AF; and 5) those with hypothyroidism 3 months before AF. Two-year mortality (up to 730 days from the cohort entry, using 90 days wash-out) was evaluated. Results During 2011-2018, a total of 122 859 patients with new-onset AF and laboratory data were included. Group 1) included 2 212 (1.8%) patients, Group 2) 1 897 (1.5%) patients, Group 3) 100 553 (81.8%), Group 4) 4 811 (3.9%) and Group 5) 13 386 (10.9%) patients (Table). In total, 14.8% of patients had a thyroid problem in history and 3.3% of patients developed a new thyroid disease at around the diagnosis of new-onset AF. Patients with hypo- or hyperthyroidism in history were the oldest and had more concomitant diseases compared to the other groups, while patients with a new hypothyroidism were the youngest (Table). Female patients had significantly more thyroid diseases compared to male patients. Patients with a history of hyperthyroidism had the poorest survival after cohort entry, while patients without any thyroid disease and with a new hypothyroidism had the best survival (crude rates), Figure. Conclusions In our nationwide cohort, 14.8% had a history of thyroid disease before the diagnosis of AF, and a new thyroid disease was diagnosed in 3.3% patients at around the diagnosis of new-onset AF. These figures seem to be higher compared to the available literature. Patients with hyperthyroidism in the history had the poorest survival.Patients with new-onset AF Mortality of patients with new-onset AF
Lund et al. (2025) conducted a cohort in new-onset atrial fibrillation (n=122,859). Hypo- and hyperthyroidism vs. No thyroid diseases was evaluated on Two-year mortality. In patients with new-onset atrial fibrillation, 14.8% had a history of thyroid disease and 3.3% had a new diagnosis, with historical hyperthyroidism associated with the poorest two-year survival.
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