Mortality in patients with atrial fibrillation and common co-morbidities – a cohort study in primary care. (17th February 2018)

• Record Type: Journal Article
• Authors: Wändell, Per; Carlsson, Axel C.; Holzmann, Martin J.; Ärnlöv, Johan; Sundquist, Jan; Sundquist, Kristina
• Is Part Of: Annals of medicine. Volume 50:Number 2(2018)
• Page Start: 156
• Page End: 163
• Publication Date: 2018-02-17
• Subjects: Coronary heart disease -- cerebrovascular disease -- depression -- congestive heart failure -- gender -- hypertension -- diabetes; Medicine -- Periodicals; 610
• DOI: 10.1080/07853890.2017.1407036
• Languages: English
• ISSNs: 0785-3890

Abstract

Abstract: Objective: To study the association between cardiovascular co-morbidities and mortality risk in primary care patients with atrial fibrillation. Methods: The study population included all adults ( n = 12, 283) ≥ 45 years diagnosed with AF at 75 primary care centres in Sweden between 2001 and 2007. The outcome was mortality (until 2010) and data were explored for co-morbidities using Cox regression with hazard ratios (HRs). Analyses were performed stratified by sex and by age-group (45–64, 65–74 and ≥75 years of age) with adjustment for age, socio-economic factors and relevant co-morbidities. Results: During a mean of 5.8 years (standard deviation 2.4) of follow-up, 3954 (32%) patients died (1971 (35%) women, and 1983 (30%) men). High HRs were found for congestive heart disease (CHF) and cerebrovascular diseases for all age-groups among men and women (except for the 45–64 year old women); for coronary heart disease among the oldest men; for diabetes among the 65–74 year old men and the 45–64 year old women. Low HRs were found for hypertension among women ≥75 years of age. Conclusions: In this clinical setting, CHF and cerebrovascular diseases were consistently associated with mortality in all age-groups. The possible protective effect by hypertension among elderly women should be interpreted with caution. KEY MESSAGES: We found congestive heart failure and cerebrovascular diseases to be consistently associated with mortality in both women and men. We found hypertension to be associated with lower mortality risk among women ≥75 years of age, although this finding must be interpreted with caution. Depression was found to be associated with increased mortality risk among men and women aged 65–74 years of age.