Multimorbidity and the risk of hospitalization and death in atrial fibrillation: A population-based study

Abstract

Background Patients with atrial fibrillation (AF) have many comorbidities and excess risks of hospitalization and death. Whether the impact of comorbidities on outcomes is greater in AF than the general population is unknown. Methods 1430 AF patients and community controls matched 1:1 on age and sex were obtained from Olmsted County, Minnesota. Andersen-Gill and Cox regression estimated associations of 19 comorbidities with hospitalization and death, respectively. Results AF cases had a higher prevalence of most comorbidities. Hypertension (25.4%), coronary artery disease (17.7%), and heart failure (13.3%) had the largest attributable risk of AF; these along with obesity and smoking explained 51.4% of AF. Over a mean follow-up of 6.3 years, AF patients experienced higher rates of hospitalization and death than population controls. However, the impact of comorbidities on hospitalization and death was generally not greater in AF patients compared to controls, with the exception of smoking. Ever smokers with AF experienced higher than expected risks of hospitalization and death, with observed vs. expected (assuming additivity of effects) hazard ratios compared to never smokers without AF of 1.78 (1.56–2.02) vs. 1.52 for hospitalization and 2.41 (2.02–2.87) vs. 1.84 for death. Conclusions Patients with AF have a higher prevalence of most comorbidities; however, the impact of comorbidities on hospitalization and death is generally similar in AF and controls. Smoking is a notable exception; ever smokers with AF experienced higher than expected risks of hospitalization and death. Thus, interventions targeting modifiable behaviors may benefit AF patients by reducing their risk of adverse outcomes.

Multimorbidity in middle age predicts more subsequent hospital admissions than in older age: A nine-year retrospective cohort study of 121,188 discharged in-patients

“…We also found that, given the same multimorbidity status, younger age groups tended to be admitted more often but older age groups tended to spend more days in hospital. As far as we know, this is the first Asian study that investigated the impact of multimorbidity over a follow-up period of more than five years [13,[25][26][27][28][29]. Our findings agreed with a previous study showing a negative age moderation effect of multimorbidity and short-term hospitalization outcomes [14].…”

“…Existing research on multimorbidity in middle age is limited. Previous studies seldom followed up participants long enough to investigate the medium-or long-term impact of multimorbidity on adverse health outcomes and burden [13,[25][26][27][28][29]. Even fewer studies stratified by age group to study the moderating effect of age [14].…”

National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018

“…Postoperative AF is well-documented, with an incidence of 8%-50%, depending on the type and site of the surgery [212][213][214][215]. AF is responsible for increasing the postoperative hospital length of stay and is an independent predictor of mortality [3,216]. Although several observational studies have suggested a survival benefit following restoration of the sinus rhythm following cardiovascular surgery [213,215,217], the most recent RCT that studied the effectiveness and safety of rate control versus rhythm control after cardiothoracic surgery showed equal duration of hospital stay and complications [218].…”

Adherence to the ABC (Atrial fibrillation Better Care) pathway in the Balkan region: the BALKAN-AF survey

“…Some studies have revealed that multimorbidity is significantly more prevalent in patients with AF than in those without AF. 21 Multimorbidity is also associated with worse survival of patients with AF, 21,22 and AF patients with multimorbidity have higher stroke and bleeding risk. The abovementioned findings should be related to prioritizing patients with AF and multimorbidity for optimal management according to the ABC pathway.…”