Impact of Atrial Fibrillation on Healthcare Utilization in the Community: The Atherosclerosis Risk in Communities Study

Bengtson, Lindsay G.S.; Lutsey, Pamela L.; Loehr, Laura R.; Kucharska‐Newton, Anna; Chen, Lin Y.; Chamberlain, Alanna M.; Wruck, Lisa; Duval, Sue; Stearns, Sally C.; Alonso, Álvaro

doi:10.1161/jaha.114.001006

Cited by 28 publications

(27 citation statements)

References 42 publications

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“…17 Exploring how trajectories in cardiovascular risk factor prevalence differ between individuals with and without AF could help to understand observed differences in healthcare utilization. Risk factor trajectories could also be clinically relevant and informative in the prevention of AF, and may provide more information than a one-time measurement.…”

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confidence: 99%

Trajectories of Cardiovascular Risk Factors and Incidence of Atrial Fibrillation Over a 25-Year Follow-Up

et al. 2016

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Background Timing and trajectories of cardiovascular risk factor (CVRF) development in relation to atrial fibrillation (AF) have not been previously described. We assessed trajectories of CVRF and incidence of AF over 25 years in the Atherosclerosis Risk in Communities (ARIC) study. Methods We assessed trajectories of CVRF in 2456 individuals with incident AF and 6414 matched controls. Subsequently, we determined the association of CVRF trajectories with the incidence of AF among 10,559 AF-free individuals (mean age 67, 52% men, 20% blacks). Risk factors were measured during 5 exams between 1987-2013. Cardiovascular events, including incident AF, were continuously ascertained. We modeled the prevalence of risk factors and cardiovascular outcomes in the period before and after AF diagnosis and the corresponding index date for controls using generalized estimating equations. Trajectories in risk factors were identified using latent mixture modeling. The risk of incident AF by trajectory group was examined using Cox models. Results The prevalence of stroke, myocardial infarction, and heart failure increased steeply during the time close to AF diagnosis. All CVRFs were elevated in AF cases compared to controls >15 years prior to diagnosis. We identified distinct trajectories for all the assessed CVRFs. In general, individuals with trajectories denoting long-term exposure to CVRFs had increased AF risk even after adjustment for single measurements of the CVRFs. Conclusion AF patients have increased prevalence of CVRF many years before disease diagnosis. This analysis identified diverse trajectories in the prevalence of these risk factors, highlighting their different roles in AF pathogenesis.

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Section: Introductionmentioning

confidence: 99%

Trajectories of Cardiovascular Risk Factors and Incidence of Atrial Fibrillation Over a 25-Year Follow-Up

et al. 2016

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“…Atrial fibrillation (AF) is the most common chronic cardiac arrhythmia in adults and is associated with adverse CVD events 8-10 . In the US, AF prevalence is expected to increase from 2.3 million currently to 5.6 million by the year 2050 and thereby require more healthcare utilization irrespective of gender or race 8, 11 . In some studies, PP has been associated with new onset AF independent of other measures of arterial pressure and other previously recognized AF risk factors 12, 13 .…”

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Gender, race, age, and regional differences in the association of pulse pressure with atrial fibrillation: the Reasons for Geographic and Racial Differences in Stroke study

Ghazi

Safford

Khodneva

et al. 2016

Journal of the American Society of Hypertension

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Background Pulse pressure (PP) has been associated with atrial fibrillation (AF) independent of other measures of arterial pressure, and other AF risk factors. However, the impact of gender, race, age, and geographic region on the association between PP and AF is unclear. Method A cross-sectional study of data from 25,109 participants (65±9 years of age), 54% women, 40% black) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study recruited between 2003 and 2007 were analyzed. AF was defined as a self-reported history of a previous physician diagnosis, or presence of AF on ECG. Multivariable logistic regression models were used to calculate the odds ratio for AF. Interactions for age (< and ≥75 years), gender, race, and region were examined in the multivariable adjusted model. Results The prevalence of AF increased with widening PP (7.9%, 7.9%, 8.4%, and 11.6%, for PP <45, 45-54.9, 55-64.9, and ≥65 mm Hg, respectively, [p for trend <0.001]), but attenuated with adjustment. No differences by gender, race, and region were observed. However, there was evidence of significant effect modification by age (interaction p=0.0002). For those <75 years of age, PP ≥65 mm Hg compared to PP<45 mm Hg was significantly associated with higher risk of AF in both the unadjusted and multivariable adjusted models (Odds Ratio 1.66 [95% CI 1.42-1.94] and 1.32 [95% CI 1.03-1.70], respectively). In contrast, higher PP (55-64.9 mm Hg) among those ≥75 years of age was significantly associated with a lower risk of AF. Conclusion The relationship between PP and AF may differ for older vs. younger individuals.

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“…7,8 Thromboembolism and its sequelae account for much of this burden. Ineffective atrial contraction results in decreased flow and stagnation of blood in atrial structures, primarily the left atrial (LA) appendage (LAA), and AF itself may represent an inflammatory and procoagulable state, further contributing to thromboembolism pathogenesis.…”

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Atrial Fibrillation Pathophysiology and Prognosis

Siontis

Gersh

2015

Circ: Cardiovascular Imaging

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Impact of Atrial Fibrillation on Healthcare Utilization in the Community: The Atherosclerosis Risk in Communities Study

Cited by 28 publications

References 42 publications

Trajectories of Cardiovascular Risk Factors and Incidence of Atrial Fibrillation Over a 25-Year Follow-Up

Trajectories of Cardiovascular Risk Factors and Incidence of Atrial Fibrillation Over a 25-Year Follow-Up

Gender, race, age, and regional differences in the association of pulse pressure with atrial fibrillation: the Reasons for Geographic and Racial Differences in Stroke study

Atrial Fibrillation Pathophysiology and Prognosis

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