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Gender-related differences in risk of cardiovascular morbidity and all-cause mortality in patients hospitalized with incident atrial fibrillation without concomitant diseases: A nationwide cohort study of 9519 patients
Dept Cardiol, Örebro Univ Hosp, Örebro, Sweden.
Clin Epidemiol & Biostat Unit, Örebro University Hospital, Örebro, Sweden.
Dept Occupat & Environm Med, Örebro University Hospital, Örebro, Sweden.
Örebro University Hospital. Dept Cardiol, Örebro University Hospital, Örebro, Sweden.
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2014 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 177, no 1, p. 91-99Article in journal (Refereed) Published
Abstract [en]

Background: Previous studies of patients with "lone" and "idiopathic" atrial fibrillation (AF) have provided conflicting evidence concerning the development, management and prognosis of this condition.

Methods: In this nation-wide, retrospective, cohort study, we studied patients diagnosed with incidental AF recorded in national Swedish registries between 1995 and 2008. Controls were matched for age, sex and calendar year of the diagnosis of AF in patients. All subjects were free of any in-hospital diagnosis from 1987 and until patients were diagnosed with AF and also free of any diagnosis within one year from the time of inclusion. Follow-up continued until 2009. We identified 9519 patients (31% women) and 12,468 matched controls.

Results: Relative risks (RR) versus controls for stroke or transient ischemic attack (TIA) in women were 19.6, 4.4, 3.4 and 2.5 in the age categories <55, 55-64, 65-74 and 75-85, years respectively. Corresponding figures for men were 3.4, 2.5, 1.7 and 1.9. RR for heart failure were 6.6, 6.6, 6.3 and 3.8 in women and 7.8, 4.6, 4.9 and 2.9 in men. All RR were statistically significant with p < 0.01. RR for myocardial infarction and all-cause mortality were statistically significantly increased only in the two oldest age categories in women and 65-74 years in men.

Conclusions: Patients with AF and no co-morbidities at inclusion had at least a doubled risk of stroke or TIA and a tripled risk of heart failure, through all age categories, as compared to controls. Women were at higher RR of stroke or TIA than men. (C) 2014 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/3.0/).

Place, publisher, year, edition, pages
Elsevier, 2014. Vol. 177, no 1, p. 91-99
Keywords [en]
Atrial fibrillation, Cardiovascular morbidity, Mortality, Cohort, Nationwide
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-56310DOI: 10.1016/j.ijcard.2014.09.092ISI: 000343895000046PubMedID: 25499348OAI: oai:DiVA.org:oru-56310DiVA, id: diva2:1081365
Note

Funding Agencies:

AstraZeneca RD Mölndal

Örebro Heart Foundation

Research Committee of Örebro University Hospital OLL 2012-265231

Available from: 2017-03-14 Created: 2017-03-14 Last updated: 2018-06-19Bibliographically approved
In thesis
1. Atrial fibrillation and cause of death, sex differences in mortality, and anticoagulation treatment in low-risk patients
Open this publication in new window or tab >>Atrial fibrillation and cause of death, sex differences in mortality, and anticoagulation treatment in low-risk patients
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Atrial fibrillation (AF) is the most common arrhythmia but information on cause of death in patients with AF is sparse, and whether individuals at low risk of cerebral infarction (CVL) should receive antico-agulant medication is controversial. Studies of sex differences with respect to mortality risk have shown conflicting results.

Methods: Data were obtained from Swedish National Registers. In Study I, there were 272 186 AF patients and matched controls and in Studies II and III, 9519 AF patients and no other diagnosis and matched controls. Study IV compared treatment with warfarin to no treatment in 48 433 patients with AF. Hazard ratio (HR) was calculated with 95% confidence intervals and outcome rates as number per 1000 person-years.

Results: Ischemic heart disease (IHD) was the most common underlying cause of death and was present in 40.2% of AF patients at a HR of 1.7 (1.4-2.1). CVL/stroke was a cause of death in 13.1%, HR 2.7 (1.8-4.0). Among underlying and contributing causes of death, the most common diagnoses were IHD in 43.5%, HR 1.7 (1.4-2.0) and heart failure in 33.1%, HR 2.9 (2.2-3.7). The HRs for mortality in females with AF in age categories ≤65, 65-74, and 75-85 were 2.15, 1.72, and 1.44, and for males 1.76, 1.36, and 1.24. The rates of mortality in females with AF in age categories 55-64, 65-74, and 75-85 were 6.2, 20.7, and 57.3, and for males 8.5, 27.3, and 64.5. In patients 65-74 years, females with a CHA2DS2-VASc score of 2, and males with a score of 1 receiving warfarin treatment showed a significantly reduced risk of cerebral infarc-tion/stroke, HR 0.46 (0.25-0.83) for females and for males, HR 0.39 (0.21-0.73).

Conclusions: Most common causes of death in AF patients were CVL/stroke, heart failure, and IHD. HR of mortality in patients with AF was higher in females than in males but absolute risk was higher in males with AF compared to females with AF. Anticoagulant therapy was benefi-cial in patients ≥65 years, regardless of the CHA2DS2-VASc score.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2018. p. 71
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 176
Keywords
Atrial fibrillation, Cerebral infarction, Anticoagulation, Cause of death, Mortality risk, Sex differences, CHA2DS2-VASc score
National Category
General Practice Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-65530 (URN)978-91-7529-236-6 (ISBN)
Public defence
2018-05-04, Örebro universitet, Campus USÖ, hörsal C2, Södra Grev Rosengatan 32, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-03-06 Created: 2018-03-06 Last updated: 2018-03-26Bibliographically approved

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