Cardiovascular and renal multimorbidity increase risk of atrial fibrillation in the PREVEND cohort

Abstract

ObjectiveAtrial fibrillation (AF) is a condition that occurs in the presence of comorbidities. With the accumulation of comorbidities (multimorbidity), some combinations may more often occur together than others. Information on the impact of clustering of these on incident AF is sparse. We aimed to investigate clustering of cardiovascular and renal comorbidities and study the association between comorbidity clusters and incident AF.MethodsWe used the community-based Prevention of Renal and Vascular ENd-stage Disease (PREVEND) cohort in which 8592 individuals participated. Latent class analysis was performed to assess clustering of 10 cardiovascular and renal comorbidities.ResultsWe excluded individuals with prior AF or missing ECG data, leaving 8265 individuals for analysis (mean age 48.9±12.6 years, 50.2% women). During 9.2±2.1 years of follow-up, 251 individuals (3.0%) developed AF. A model with three clusters was the optimal model, with one cluster being young (44.5±10.8 years) and healthy, carrying a low (1.0%) risk of incident AF; one cluster being older (63.0±8.4 years) and multimorbid, carrying a high (16.2%) risk of incident AF and a third middle-aged (57.0±11.3 years), obese and hypertensive cluster carrying an intermediate risk (5.9%) of incident AF. While the prevalence of the comorbidities differed between classes, no clear combination(s) of comorbidities was observed within the classes.ConclusionsWe identified three clusters of comorbidities in individuals in the community-based PREVEND cohort. The three clusters contained different amount of comorbidities carrying different risks of incident AF. However, there were no differences between the clusters regarding specific combination(s) of comorbidities.

Multimorbidity in patients with atrial fibrillation

“…The comorbidities associated with AF can range from common conditions such as hypertension and diabetes mellitus to more complex conditions such as obesity, renal impairment and heart failure. 7 Multimorbidity is often subdivided into cardiovascular and non-cardiovascular comorbidities, or clustering of comorbidities that are inherently interconnected, such as obesity and physical inactivity. 4 6 Moreover, mental comorbidities (eg, depression and anxiety and social determinants, eg, socioeconomic status, race and ethnicity, financial resources, social support, access to healthcare, rurality and residential environment, local language proficiency and health literacy), 8 have emerged as potential contributors to the occurrence of AF.…”