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
Fig. 1
Prevalence of AF in the Polish population with (DM+) and without (DM−) concomitant diabetes mellitus in correlation to age. *p 

Fig. 2

Prevalence of asymptomatic, silent atrial…

Fig. 2

Prevalence of asymptomatic, silent atrial fibrillation (SAF) in the Polish population with (DM+)…

Fig. 2
Prevalence of asymptomatic, silent atrial fibrillation (SAF) in the Polish population with (DM+) and without (DM-) concomitant diabetes mellitus in correlation to age. *p 
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Fig. 2
Fig. 2
Prevalence of asymptomatic, silent atrial fibrillation (SAF) in the Polish population with (DM+) and without (DM-) concomitant diabetes mellitus in correlation to age. *p 

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