4.8 Article

Temporal trends in cause-specific mortality among individuals with newly diagnosed atrial fibrillation in the Framingham Heart Study

Journal

BMC MEDICINE
Volume 19, Issue 1, Pages -

Publisher

BMC
DOI: 10.1186/s12916-021-02037-x

Keywords

Atrial fibrillation; Death; Temporal trends; Cardiovascular mortality; Epidemiology

Funding

  1. National Heart, Lung, and Blood Institute [NO-1HC-25195, HHSN268201500001I, 75N92019D00031]
  2. European Union [838259]
  3. NIH [5R01HL128914-04, 1R01HL139731]
  4. American Heart Association [18SFRN34250007, AHA 18SFRN34110082, 18SFRN34150007]
  5. American College of Cardiology Foundation/Merck Research Fellowship in Cardiovascular Diseases and Cardiometabolic Disorders
  6. [R01 HL092577-06S1]
  7. [2R01 HL092577]
  8. [1R01 HL141434 01A1]
  9. [2U54HL120163]
  10. [1R01AG066010]
  11. [1R01AG066914]

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The study found that cardiovascular mortality among atrial fibrillation (AF) cases decreased over time, regardless of age. With advancing age, history of heart failure, and history of myocardial infarction, the risk of cardiovascular death also increased.
Background All-cause mortality following atrial fibrillation (AF) has decreased over time. Data regarding temporal trends in causes of death among individuals with AF are scarce. The aim of our study was to analyze temporal trends in cause-specific mortality and predictors for cardiovascular (CVD) and non-CVD deaths among participants with incident AF in the Framingham Heart Study. Methods We categorized all newly diagnosed AF cases according to age at AF diagnosis (< 70, 70 to < 80, and >= 80 years) and epoch of AF diagnosis (< 1990, 1990-2002, and >= 2003). We followed participants until death or the last follow-up. We categorized death causes into CVD, non-CVD, and unknown causes. For each age group, we tested for trends in the cumulative incidence of cause-specific death across epochs. We fit multivariable Fine-Gray models to assess subdistribution hazard ratios (HR) between clinical risk factors at AF diagnosis and cause-specific mortality. Results We included 2125 newly diagnosed AF cases (mean age 75.5 years, 47.8% women). During a median follow-up of 4.8 years, 1657 individuals with AF died. There was evidence of decreasing CVD mortality among AF cases diagnosed < 70 years and 70 to < 80 years (p(trend) < 0.001) but not >= 80 years (p = 0.76). Among the cases diagnosed < 70 years, the cumulative incidence of CVD death at 75 years was 67.7% in epoch 1 and 13.9% in epoch 3; among those 70 to < 80 years, the incidence at 85 years was 58.9% in epoch 1 and 18.9% in epoch 3. Advancing age (HR per 1 SD increase 6.33, 95% CI 5.44 to 7.37), prior heart failure (HR 1.49, 95% CI 1.14-1.94), and prior myocardial infarction (HR 1.44, 95% CI 1.15-1.80) were associated with increased rate of CVD death. Conclusions In this community-based cohort, CVD mortality among AF cases decreased over time. Most deaths in individuals with AF are no longer CVD-related, regardless of age at AF diagnosis.

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