Key result
The presence of diabetes mellitus in patients with atrial fibrillation was associated with a 40% increased risk of all-cause mortality (aHR 1.40) compared to patients without diabetes.
Why the study?
Data were limited on the association of diabetes mellitus and glycated hemoglobin levels with outcomes in patients with atrial fibrillation.
Does the presence of diabetes mellitus and specific HbA1c levels increase the risk of mortality and adverse cardiovascular outcomes in patients with atrial fibrillation?
Cohort (n=1,109)
No
Does the presence of diabetes mellitus and specific HbA1c levels increase the risk of mortality and adverse cardiovascular outcomes in patients with atrial fibrillation?
Effect estimate: aHR 1.40 (95% CI 1.11-1.75)
Absolute Event Rate: 45.8% vs 33%
In patients with atrial fibrillation, comorbid diabetes mellitus and HbA1c levels ≥7.6% are independently associated with significantly increased risks of all-cause and cardiovascular mortality.
BACKGROUND: There are limited data on the association of diabetes mellitus (DM) and levels of glycated hemoglobin (HbA1c) with outcomes in patients with atrial fibrillation (AF). METHODS: This retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 2018. Kaplan-Meier curves and Cox-regression adjusted hazard ratios (aHR) were calculated for the primary outcome of all-cause mortality and for the secondary outcomes of cardiovascular (CV) mortality and the composite outcome of CV death or hospitalization. Competing-risk regression analyses were performed to calculate the cumulative risk of stroke, major bleeding, AF- or HF-hospitalizations adjusted for the competing risk of all-cause death. Spline curve models were fitted to investigate associations of HbA1c values and mortality among patients with AF and DM. RESULTS: In total 1109 AF patients were included, of whom 373 (33.6%) had DM. During a median follow-up of 2.6 years, 414 (37.3%) patients died. The presence of DM was associated with a higher risk of all-cause mortality (aHR = 1.40 95% confidence intervals [CI] 1.11-1.75), CV mortality (aHR = 1.39, 95% CI 1.07-1.81), sudden cardiac death (aHR = 1.73, 95% CI 1.19-2.52), stroke (aHR = 1.87, 95% CI 1.01-3.45) and the composite outcome of hospitalization or CV death (aHR = 1.27, 95% CI 1.06-1.53). In AF patients with comorbid DM, the spline curves showed a positive linear association between HbA1c levels and outcomes, with values 7.6-8.2% being independent predictors of increased all-cause mortality, and values < 6.2% predicting significantly decreased all-cause and CV mortality. CONCLUSIONS: The presence of DM on top of AF was associated with substantially increased risk for all-cause or CV mortality, sudden cardiac death and excess morbidity. HbA1c levels lower than 6.2% were independently related to better survival rates suggesting that optimal DM control could be associated with better clinical outcomes in AF patients with DM.
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Papazoglou et al. (2021) conducted a cohort in Atrial fibrillation (n=1,109). Diabetes mellitus vs. No diabetes mellitus was evaluated on All-cause mortality (aHR 1.40, 95% CI 1.11-1.75). The presence of diabetes mellitus in patients with atrial fibrillation was associated with a 40% increased risk of all-cause mortality (aHR 1.40) compared to patients without diabetes.
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