High overall cardiovascular risk and mortality in patients with atrial fibrillation and diabetes: A nationwide report

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Abstract

Aim:

To describe nationwide complication patterns in patients with atrial fibrillation and diabetes mellitus.

Methods:

All (n = 326,832) patients in Sweden with non-valvular atrial fibrillation during 2006–2012 were identified, and information on events, comorbidities and pharmacological therapy was extracted using nationwide mandatory registers. Patients were followed until 31 December 2013 and the mean follow-up time was 3.7 years (0.9–8 years).

Results:

Diabetes was present in 17.7%. The most frequent events in those with and without diabetes were mortality (48.8% vs 36.4%; p < 0.001), heart failure (21.4% vs 13.1%; p < 0.001), ischaemic stroke (8.2% vs 6.8%; p < 0.001), myocardial infarction (7.3% vs 4.3%; p < 0.001) and any bleeding (6.3% vs 5.2%; p < 0.001), respectively. Diabetes predicted mortality (hazard ratio = 1.28; 95% confidence interval = 1.25–1.31), combined event (first of mortality, heart failure, ischaemic stroke or myocardial infarction; hazard ratio = 1.22; 95% confidence interval = 1.20–1.25), single events and bleeding (hazard ratio = 1.12; 95% confidence interval = 1.06–1.19). The standardised mortality ratio for patients with atrial fibrillation and diabetes compared to the general population was 2.06 (95% confidence interval = 2.00–2.12) and for patients with atrial fibrillation without diabetes was 1.33 (95% confidence interval = 1.31–1.35).

Conclusion:

In this real-world setting, patients with atrial fibrillation and diabetes have a high cardiovascular risk, with mortality and heart failure rates exceeding those for stroke.

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