2960-LB: Diabetes and Obesity as a Gateway to Atrial Fibrillation: Incidence, Burden, and Predictors among Eight Million Adults

Introduction and Objective: Type 2 diabetes (T2D) and obesity are independent AF risk factors and obesity may account for up to one-fifth of AF cases. Using administrative claims, we quantified AF incidence, and cumulative burden, in adults with T2D and obesity. Methods: We conducted a retrospective RWE cohort study using the Symphony administrative claims database (2018-2025). Adults with coexisting obesity and T2D with ≥12 months of continuous enrollment and no prior AF were identified. Follow-up continued until incident AF, disenrollment, death, or end of data. Overall incident AF rates (per 100 patient-years) and cumulative AF incidence for patients at risk till end of follow-up were calculated using Kaplan-Meier methods. Multivariable Cox regression identified risk of post AF outcomes. Results: Among 8,166,278 adults with T2D and obesity (mean age 67 years; 46% female), 635,233 (7.8%) developed AF (incidence rate 1.886 per 100 patient-years, 95% CI 1.881-1.891). Cumulative AF incidence rose from 1.5% at 6 months to 12.9% at 84 months. Post AF mortality risks were associated with age ≥75 years (HR 2.84), heart failure (HR 2.20), chronic kidney disease (HR 2.14), coronary atherosclerosis (HR 1.43), and hypertension (HR 1.46). Conclusion: These findings support AF screening in diabetes clinics and earlier detection of downstream cardiovascular and kidney disease risk. Disclosure P. Russo: None. R. Nathan: None. W. Poh: None. K. Boyle: Employee; Current; iRhythm Technologies. B. Wright: None. E.M. Hendrickson: Employee; Current; iRhythm Technologies.