Association of Diabetes With Atrial Fibrillation Phenotype and Cardiac and Neurological Comorbidities: Insights From the Swiss-AF Study

Arjola Bano, Nicolas Rodondi, Jürg H Beer, Giorgio Moschovitis, Richard Kobza, Stefanie Aeschbacher, Oliver Baretella, Taulant Muka, Christoph Stettler, Oscar H Franco, Giulio Conte, Christian Sticherling, Christine S Zuern, David Conen, Michael Kühne, Stefan Osswald, Laurent Roten, Tobias Reichlin, of the Swiss‐Investigators, Arjola Bano, Nicolas Rodondi, Jürg H Beer, Giorgio Moschovitis, Richard Kobza, Stefanie Aeschbacher, Oliver Baretella, Taulant Muka, Christoph Stettler, Oscar H Franco, Giulio Conte, Christian Sticherling, Christine S Zuern, David Conen, Michael Kühne, Stefan Osswald, Laurent Roten, Tobias Reichlin, of the Swiss‐Investigators

Abstract

Background Diabetes is a major risk factor for atrial fibrillation (AF). However, it remains unclear whether individual AF phenotype and related comorbidities differ between patients who have AF with and without diabetes. This study investigated the association of diabetes with AF phenotype and cardiac and neurological comorbidities in patients with documented AF. Methods and Results Participants in the multicenter Swiss-AF (Swiss Atrial Fibrillation) study with data on diabetes and AF phenotype were eligible. Primary outcomes were parameters of AF phenotype, including AF type, AF symptoms, and quality of life (assessed by the European Quality of Life-5 Dimensions Questionnaire [EQ-5D]). Secondary outcomes were cardiac (ie, history of hypertension, myocardial infarction, and heart failure) and neurological (ie, history of stroke and cognitive impairment) comorbidities. The cross-sectional association of diabetes with these outcomes was assessed using logistic and linear regression, adjusted for age, sex, and cardiovascular risk factors. We included 2411 patients with AF (27.4% women; median age, 73.6 years). Diabetes was not associated with nonparoxysmal AF (odds ratio [OR], 1.01; 95% CI, 0.81-1.27). Patients with diabetes less often perceived AF symptoms (OR, 0.74; 95% CI, 0.59-0.92) but had worse quality of life (β=-4.54; 95% CI, -6.40 to -2.68) than those without diabetes. Patients with diabetes were more likely to have cardiac (hypertension [OR, 3.04; 95% CI, 2.19-4.22], myocardial infarction [OR, 1.55; 95% CI, 1.18-2.03], heart failure [OR, 1.99; 95% CI, 1.57-2.51]) and neurological (stroke [OR, 1.39, 95% CI, 1.03-1.87], cognitive impairment [OR, 1.75, 95% CI, 1.39-2.21]) comorbidities. Conclusions Patients who have AF with diabetes less often perceive AF symptoms but have worse quality of life and more cardiac and neurological comorbidities than those without diabetes. This raises the question of whether patients with diabetes should be systematically screened for silent AF. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02105844.

Keywords: atrial fibrillation; cardiovascular disease; cognitive impairment; diabetes; quality of life.

Figures

Figure 1. Association of diabetes with atrial…
Figure 1. Association of diabetes with atrial fibrillation (AF) phenotype and cardiac and neurological comorbidities.
A, Age‐ and sex‐ adjusted odds ratios (ORs) and 95% CIs are derived based on logistic regression. The vertical line represents an OR of 1. B, Age‐ and sex‐adjusted beta regression coefficient (β) and 95% CIs are derived based on linear regression. The vertical line represents a β of 0. The quality‐of‐life score ranges from 0 to 100, with higher values indicating better quality of life.

References

    1. Huxley RR, Filion KB, Konety S, Alonso A. Meta‐analysis of cohort and case‐control studies of type 2 diabetes mellitus and risk of atrial fibrillation. Am J Cardiol. 2011;108:56–62. doi: 10.1016/j.amjcard.2011.03.004
    1. Bohne LJ, Johnson D, Rose RA, Wilton SB, Gillis AM. The association between diabetes mellitus and atrial fibrillation: clinical and mechanistic insights. Front Physiol. 2019;10:135. doi: 10.3389/fphys.2019.00135
    1. Tadic M, Cuspidi C. Type 2 diabetes mellitus and atrial fibrillation: from mechanisms to clinical practice. Arch Cardiovasc Dis. 2015;108:269–276. doi: 10.1016/j.acvd.2015.01.009
    1. Echouffo‐Tcheugui JB, Shrader P, Thomas L, Gersh BJ, Kowey PR, Mahaffey KW, Singer DE, Hylek EM, Go AS, Peterson ED, et al. Care patterns and outcomes in atrial fibrillation patients with and without diabetes: ORBIT‐AF registry. J Am Coll Cardiol. 2017;70:1325–1335. doi: 10.1016/j.jacc.2017.07.755
    1. Sugishita K, Shiono E, Sugiyama T, Ashida T. Diabetes influences the cardiac symptoms related to atrial fibrillation. Circ J. 2003;67:835–838. doi: 10.1253/circj.67.835
    1. Bakhai A, Darius H, De Caterina R, Smart A, Le Heuzey JY, Schilling RJ, Zamorano JL, Shah M, Bramlage P, Kirchhof P. Characteristics and outcomes of atrial fibrillation patients with or without specific symptoms: results from the PREFER in AF registry. Eur Heart J – Qual Care Clin Outcomes. 2016;2(4):299–305. doi: 10.1093/ehjqcco/qcw031
    1. Freeman JV, Simon DN, Go AS, Spertus J, Fonarow GC, Gersh BJ, Hylek EM, Kowey PR, Mahaffey KW, Thomas LE, et al. Association between atrial fibrillation symptoms, quality of life, and patient outcomes: results from the outcomes registry for better informed treatment of atrial fibrillation (ORBIT‐AF). Circ Cardiovasc Qual Outcomes. 2015;8:393–402. doi: 10.1161/CIRCOUTCOMES.114.001303
    1. Reynolds MR, Lavelle T, Essebag V, Cohen DJ, Zimetbaum P. Influence of age, sex, and atrial fibrillation recurrence on quality of life outcomes in a population of patients with new‐onset atrial fibrillation: the Fibrillation Registry Assessing Costs, Therapies, Adverse events and Lifestyle (FRACTAL) study. Am Heart J. 2006;152:1097–1103. doi: 10.1016/j.ahj.2006.08.011
    1. Ruperti Repilado FJ, Doerig L, Blum S, Aeschbacher S, Krisai P, Ammann P, Erne P, Moschovitis G, di Valentino M, Shah D, et al. Prevalence and predictors of atrial fibrillation type among individuals with recent onset of atrial fibrillation. Swiss Med Wkly. 2018;148:w14652. doi: 10.4414/smw.2018.14652
    1. Kadappu KK, Boyd A, Eshoo S, Haluska B, Yeo AE, Marwick TH, Thomas L. Changes in left atrial volume in diabetes mellitus: more than diastolic dysfunction? Eur Heart J Cardiovasc Imaging. 2012;13:1016–1023. doi: 10.1093/ehjci/jes084
    1. van Oort S, Beulens JW, van Ballegooijen AJ, Grobbee DE, Larsson SC. Association of cardiovascular risk factors and lifestyle behaviors with hypertension: a mendelian randomization study. Hypertension. 1979;2020(76):1971–1979.
    1. Sun D, Zhou T, Heianza Y, Li X, Fan M, Fonseca VA, Qi L. Type 2 diabetes and hypertension. Circ Res. 2019;124:930–937. doi: 10.1161/CIRCRESAHA.118.314487
    1. The Stroke Risk in Atrial Fibrillation Working Group . Independent predictors of stroke in patients with atrial fibrillation: a systematic review. Neurology. 2007;69:546–554. doi: 10.1212/01.wnl.0000267275.68538.8d
    1. Ball J, Carrington MJ, Stewart S. Mild cognitive impairment in high‐risk patients with chronic atrial fibrillation: a forgotten component of clinical management? Heart. 2013;99:542–547. doi: 10.1136/heartjnl-2012-303182
    1. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the national registry of atrial fibrillation. JAMA. 2001;285:2864–2870. doi: 10.1001/jama.285.22.2864
    1. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor‐based approach: the Euro Heart Survey on Atrial Fibrillation. Chest. 2010;137:263–272. doi: 10.1378/chest.09-1584
    1. Wang TJ, Massaro JM, Levy D, Vasan RS, Wolf PA, D'Agostino RB, Larson MG, Kannel WB, Benjamin EJ. A risk score for predicting stroke or death in individuals with new‐onset atrial fibrillation in the community: the Framingham Heart study. JAMA. 2003;290:1049–1056. doi: 10.1001/jama.290.8.1049
    1. Conen D, Rodondi N, Mueller A, Beer J, Auricchio A, Ammann P, Hayoz D, Kobza R, Moschovitis G, Shah D, et al. Design of the Swiss atrial fibrillation cohort study (SWISS‐AF): structural brain damage and cognitive decline among patients with atrial fibrillation. Swiss Med Wkly. 2017;147:w14467.
    1. Conen D, Rodondi N, Müller A, Beer JH, Ammann P, Moschovitis G, Auricchio A, Hayoz D, Kobza R, Shah D, et al. Relationships of overt and silent brain lesions with cognitive function in patients with atrial fibrillation. J Am Coll Cardiol. 2019;73:989–999. doi: 10.1016/j.jacc.2018.12.039
    1. Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al‐Attar N, Hindricks G, Prendergast B, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010;31:2369–2429. doi: 10.1093/eurheartj/ehq278
    1. Räsänen P, Roine E, Sintonen H, Semberg‐Konttinen V, Ryynänen OP, Roine R. Use of quality‐adjusted life years for the estimation of effectiveness of health care: a systematic literature review. Int J Technol Assess Health Care. 2006;22:235–241. doi: 10.1017/S0266462306051051
    1. Witassek F, Springer A, Adam L, Aeschbacher S, Beer JH, Blum S, Bonati LH, Conen D, Kobza R, Kühne M, et al. Health‐related quality of life in patients with atrial fibrillation: the role of symptoms, comorbidities, and the type of atrial fibrillation. PLoS One. 2019;14:e0226730. doi: 10.1371/journal.pone.0226730
    1. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695–699. doi: 10.1111/j.1532-5415.2005.53221.x
    1. Gersh B, Braunwald E, Bonow RO. Silent Myocardial Ischemia. Heart Disease: A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia: Saunders; 2001:1330–1332.
    1. O’Rourke RA, Schlant RC. Asymptomatic (silent) ischemia in stable cad. In: Fuster V, Alexander RW, O’rourke RA, eds. Hurst’s the Heart. 10th ed. New York: Mcgraw‐Hill; 2001:1219–1220.
    1. Langer A, Freeman MR, Josse RG, Armstrong PW. Metaiodobenzylguanidine imaging in diabetes mellitus: assessment of cardiac sympathetic denervation and its relation to autonomic dysfunction and silent myocardial ischemia. J Am Coll Cardiol. 1995;25:610–618. doi: 10.1016/0735-1097(94)00459-4
    1. Rizzo MR, Sasso FC, Marfella R, Siniscalchi M, Paolisso P, Carbonara O, Capoluongo MC, Lascar N, Pace C, Sardu C, et al. Autonomic dysfunction is associated with brief episodes of atrial fibrillation in type 2 diabetes. J Diabetes Complicat. 2015;29:88–92. doi: 10.1016/j.jdiacomp.2014.09.002
    1. Wang A, Green JB, Halperin JL, Piccini JP Sr. Atrial fibrillation and diabetes mellitus: JACC review topic of the week. J Am Coll Cardiol. 2019;74:1107–1115. doi: 10.1016/j.jacc.2019.07.020
    1. Fumagalli S, Said SA, Laroche C, Gabbai D, Boni S, Marchionni N, Boriani G, Maggioni AP, Musialik‐Lydka A, Sokal A, et al. Management and prognosis of atrial fibrillation in diabetic patients: an EORP‐AF general pilot registry report. Eur Heart J Cardiovasc Pharmacother. 2018;4:172–179. doi: 10.1093/ehjcvp/pvx037
    1. Boriani G, Laroche C, Diemberger I, Fantecchi E, Popescu MI, Rasmussen LH, Dan GA, Kalarus Z, Tavazzi L, Maggioni AP, et al. 'Real‐world' management and outcomes of patients with paroxysmal vs. Non‐paroxysmal atrial fibrillation in Europe: the EURObservational Research Programme–Atrial Fibrillation (EORP‐AF) General Pilot Registry. Europace. 2016;18:648.1–657. doi: 10.1093/europace/euv390
    1. Sandhu RK, Conen D, Tedrow UB, Fitzgerald KC, Pradhan AD, Ridker PM, Glynn RJ, Albert CM. Predisposing factors associated with development of persistent compared with paroxysmal atrial fibrillation. J Am Heart Assoc. 2014;3:e000916. doi: 10.1161/JAHA.114.000916
    1. Wang T, Ma X, Tang T, Jin L, Peng D, Zhang R, Chen M, Yan J, Wang S, Yan D, et al. Overall and central obesity with insulin sensitivity and secretion in a Han Chinese population: a Mendelian randomization analysis. Int J Obes. 2005;2016:1736–1741. doi: 10.1038/ijo.2016.155
    1. Berg J, Lindgren P, Nieuwlaat R, Bouin O, Crijns H. Factors determining utility measured with the EQ‐5D in patients with atrial fibrillation. Qual Life Res. 2010;19:381–390. doi: 10.1007/s11136-010-9591-y
    1. Bostrom JA, Saczynski JS, Hajduk A, Donahue K, Rosenthal LS, Browning C, Ennis C, Floyd KC, Richardson H, Esa N, et al. Burden of psychosocial and cognitive impairment in patients with atrial fibrillation. Crit Pathw Cardiol. 2017;16:71–75. doi: 10.1097/HPC.0000000000000101
    1. Madonna R, De Caterina R. Cellular and molecular mechanisms of vascular injury in diabetes–part I: pathways of vascular disease in diabetes. Vascul Pharmacol. 2011;54:68–74. doi: 10.1016/j.vph.2011.03.005
    1. Madonna R, De Caterina R. Cellular and molecular mechanisms of vascular injury in diabetes–part II: cellular mechanisms and therapeutic targets. Vascul Pharmacol. 2011;54:75–79. doi: 10.1016/j.vph.2011.03.007

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner