Relationship between diabetes mellitus and atrial fibrillation prevalence in the Polish population: a report from the Non-invasive Monitoring for Early Detection of Atrial Fibrillation (NOMED-AF) prospective cross-sectional observational study
Jakub Gumprecht, Gregory Y H Lip, Adam Sokal, Beata Średniawa, Katarzyna Mitręga, Jakub Stokwiszewski, Łukasz Wierucki, Aleksandra Rajca, Marcin Rutkowski, Tomasz Zdrojewski, Tomasz Grodzicki, Jarosław Kaźmierczak, Grzegorz Opolski, Zbigniew Kalarus, Jakub Gumprecht, Gregory Y H Lip, Adam Sokal, Beata Średniawa, Katarzyna Mitręga, Jakub Stokwiszewski, Łukasz Wierucki, Aleksandra Rajca, Marcin Rutkowski, Tomasz Zdrojewski, Tomasz Grodzicki, Jarosław Kaźmierczak, Grzegorz Opolski, Zbigniew Kalarus
Abstract
Background: The global burden of atrial fibrillation (AF) and diabetes mellitus (DM) is constantly rising, leading to an increasing healthcare burden of stroke. AF often remains undiagnosed due to the occurrence in an asymptomatic, silent form, i.e., silent AF (SAF). The study aims to evaluate the relationships between DM and AF prevalence using a mobile long-term continuous ECG telemonitoring vest in a representative Polish and European population ≥ 65 years for detection of AF, symptomatic or silent.
Methods: A representative sample of 3014 participants from the cross-sectional NOMED-AF study was enrolled in the analyses (mean age 77.5, 49.1% female): 881 (29.2%) were diagnosed with DM. AF was screened using a telemonitoring vest for a mean of 21.9 ± 9.1days.
Results: Overall, AF was reported in 680 (22.6%) of the whole study population. AF prevalence was higher among subjects with concomitant DM (DM+) versus those without DM (DM-) [25%, 95% CI 22.5-27.8% vs 17%; 95% CI 15.4-18.5% respectively, p < 0.001]. DM patients were commonly associated with SAF [9%; 95% CI 7.9-11.4 vs 7%; 95% CI 5.6-7.5 respectively, p < 0.001], and persistent/permanent AF [12.2%; 95% CI 10.3-14.3 vs 6.9%; 95% CI 5.9-8.1 respectively, p < 0.001] compared to subjects without DM. The prolonged screening was associated with a higher percentage of newly established AF diagnosis in DM+ vs DM- patients (5% vs 4.5% respectively, p < 0.001). In addition to shared risk factors, DM+ subjects were associated with different AF and SAF independent risk factors compared to DM- individuals, including thyroid disease, peripheral/systemic thromboembolism, hypertension, physical activity and prior percutaneous coronary intervention/coronary artery bypass graft surgery.
Conclusions: AF affects 1 out of 4 subjects with concomitant DM. The higher prevalence of AF and SAF among DM subjects than those without DM highlights the necessity of active AF screening specific AF risk factors assessment amongst the diabetic population.
Trial registration: NCT03243474.
Keywords: Atrial fibrillation; Diabetes mellitus; Epidemiology; Long-term monitoring; Prevalence.
Conflict of interest statement
Gregory Y. H. Lip – Consultant and speaker for BMS/Pfizer, Boehringer Ingelheim and Daiichi-Sankyo. No fees are received personally. Other authors declare no conflict of interests.
Figures
![Fig. 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8228888/bin/12933_2021_1318_Fig1_HTML.jpg)
Fig. 2
Prevalence of asymptomatic, silent atrial…
Fig. 2
Prevalence of asymptomatic, silent atrial fibrillation (SAF) in the Polish population with (DM+)…
- Prevalence of atrial fibrillation in the 65 or over Polish population. Report of cross-sectional NOMED-AF study.Kalarus Z, Średniawa B, Mitręga K, Wierucki Ł, Sokal A, Lip G, Bandosz P, Stokwiszewski J, Boidol J, Zieleniewicz P, Rutkowski M, Kaźmierczak J, Opolski G, Grodzicki T, Zdrojewski T. Kalarus Z, et al. Kardiol Pol. 2023;81(1):14-21. doi: 10.33963/KP.a2022.0202. Epub 2022 Aug 31. Kardiol Pol. 2023. PMID: 36043418
- Effect of a Home-Based Wearable Continuous ECG Monitoring Patch on Detection of Undiagnosed Atrial Fibrillation: The mSToPS Randomized Clinical Trial.Steinhubl SR, Waalen J, Edwards AM, Ariniello LM, Mehta RR, Ebner GS, Carter C, Baca-Motes K, Felicione E, Sarich T, Topol EJ. Steinhubl SR, et al. JAMA. 2018 Jul 10;320(2):146-155. doi: 10.1001/jama.2018.8102. JAMA. 2018. PMID: 29998336 Free PMC article. Clinical Trial.
- Assessment of Remote Heart Rhythm Sampling Using the AliveCor Heart Monitor to Screen for Atrial Fibrillation: The REHEARSE-AF Study.Halcox JPJ, Wareham K, Cardew A, Gilmore M, Barry JP, Phillips C, Gravenor MB. Halcox JPJ, et al. Circulation. 2017 Nov 7;136(19):1784-1794. doi: 10.1161/CIRCULATIONAHA.117.030583. Epub 2017 Aug 28. Circulation. 2017. PMID: 28851729 Clinical Trial.
- Comprehensive Evaluation of Rhythm Monitoring Strategies in Screening for Atrial Fibrillation: Insights From Patients at Risk Monitored Long Term With an Implantable Loop Recorder.Diederichsen SZ, Haugan KJ, Kronborg C, Graff C, Højberg S, Køber L, Krieger D, Holst AG, Nielsen JB, Brandes A, Svendsen JH. Diederichsen SZ, et al. Circulation. 2020 May 12;141(19):1510-1522. doi: 10.1161/CIRCULATIONAHA.119.044407. Epub 2020 Mar 2. Circulation. 2020. PMID: 32114796 Clinical Trial.
- Predicting Silent Atrial Fibrillation in the Elderly: A Report from the NOMED-AF Cross-Sectional Study.Mitrega K, Lip GYH, Sredniawa B, Sokal A, Streb W, Przyludzki K, Zdrojewski T, Wierucki L, Rutkowski M, Bandosz P, Kazmierczak J, Grodzicki T, Opolski G, Kalarus Z. Mitrega K, et al. J Clin Med. 2021 May 26;10(11):2321. doi: 10.3390/jcm10112321. J Clin Med. 2021. PMID: 34073411 Free PMC article.
- Surgical ablation for atrial fibrillation: impact of Diabetes Mellitus type 2.Kogan A, Grupper A, Sabbag A, Ram E, Jamal T, Nof E, Fisman EZ, Levin S, Beinart R, Frogel J, Raanani E, Sternik L. Kogan A, et al. Cardiovasc Diabetol. 2023 Mar 31;22(1):77. doi: 10.1186/s12933-023-01810-x. Cardiovasc Diabetol. 2023. PMID: 37004023 Free PMC article.
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- Andersson T, Magnuson A, Bryngelsson I-L, Frøbert O, Henriksson KM, Edvardsson N, et al. All-cause mortality in 272 186 patients hospitalized with incident atrial fibrillation 1995–2008: a Swedish nationwide long-term case–control study. Eur Heart J. 2013;34:1061–7. doi: 10.1093/eurheartj/ehs469. - DOI - PMC - PubMed
- Observational Study
- Research Support, Non-U.S. Gov't
- Aged
- Aged, 80 and over
- Asymptomatic Diseases
- Atrial Fibrillation / diagnosis
- Atrial Fibrillation / epidemiology*
- Comorbidity
- Cross-Sectional Studies
- Diabetes Mellitus / diagnosis
- Diabetes Mellitus / epidemiology*
- Early Diagnosis
- Electrocardiography, Ambulatory / instrumentation
- Female
- Humans
- Male
- Poland / epidemiology
- Predictive Value of Tests
- Prevalence
- Prospective Studies
- Remote Sensing Technology / instrumentation
- Risk Assessment
- Risk Factors
- Wearable Electronic Devices
- ClinicalTrials.gov/NCT03243474
- Full Text Sources
- Medical
![Fig. 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8228888/bin/12933_2021_1318_Fig2_HTML.jpg)
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