Key result
Stroke in older AF patients is linked to a ~32% absolute decrease in ADL independence.
Why the study?
Long-term function and the contribution of strokes to disability in older adults with atrial fibrillation had not been previously characterized.
Does incident stroke accelerate long-term functional decline in older adults with atrial fibrillation compared to their baseline rate of decline?
Observational (n=3,530)
Yes
Does incident stroke accelerate long-term functional decline in older adults with atrial fibrillation compared to their baseline rate of decline?
Stroke-associated ADL loss in older AF adults is modest relative to background decline; leaves open acceleration beyond baseline rates.
BACKGROUND: Older adults with atrial fibrillation (AF) have multiple risk factors for disablement. Long-term function and the contribution of strokes to disability has not been previously characterized. METHODS: We performed a longitudinal, observational study in the nationally representative Health and Retirement Study (1992-2014). We included participants ≥65 years with Medicare claims who met incident AF diagnosis claims criteria. We examined the association of incident stroke with three functional outcomes: independence with activities of daily living (ADL) and instrumental activities of daily living (IADL) and community-dwelling. We fit separate logistic regression models with repeated measures adjusting for comorbidities and demographics to estimate the effect of stroke on function. We estimate the contribution of strokes to the overall population burden of functional impairment using the method of recycled predictions. Independent of stroke and accounting for population comorbidities, annually, ADL dependence increased by 4.4%, IADL dependence increased by 3.9%, and nursing home residence increased by 1.2% (p<0.05 for all). Accounting for comorbidities, of those who experienced a stroke, 31.9% developed new ADL dependence, 26.5% developed new IADL dependence, and 8.6% newly moved to a nursing home (p<0.05 for all). Considering all causes of function loss, 1.7% of ADL disability-years, 1.2% of IADL disability-years, and 7.3% of nursing home years could be attributed to stroke over 7.4years. CONCLUSION: Older adults lose substantial function over time following AF diagnosis, independent of stroke. Stroke was associated with a significant decline in function and an increase in the likelihood of nursing home move, but stroke did not accelerate subsequent disability accrual. Because of the high background rate of functional loss, stroke was not the dominant determinant of population-level disability in older adults with AF. IMPACT STATEMENT: We certify that this work is novel. Little is known about long-term function (ADL, IADL, community-dwelling) among older adults with AF and the association with stroke. This nationally representative study finds a high rate of function loss independent of stroke, and among those who suffer a stroke, a dramatic and immediate decline in function. Because of the high rate of function loss independent of stroke and the relatively low rate of stroke, on a population level, stroke is not the dominant determinant of disability in older adults with AF.
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Parks et al. (2020) conducted an observational in Atrial fibrillation (n=3,530). Incident stroke vs. Pre-stroke baseline / No stroke was evaluated on ADL independence (AME -32%, 95% CI -39 to -25, p=<0.05). Among older adults with atrial fibrillation, stroke was associated with a 32% absolute decrease in ADL independence, though the majority of long-term functional decline occurred independent of stroke.
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