Mortality in patients with atrial fibrillation and common co-morbidities – a cohort study in primary care

Abstract

Objective: To study the association between cardiovascular co-morbidities and mortality risk in primary care patients with atrial fibrillation.

Methods: The study population included all adults (n = 12,283) ≥ 45 years diagnosed with AF at 75 primary care centres in Sweden between 2001 and 2007. The outcome was mortality (until 2010) and data were explored for co-morbidities using Cox regression with hazard ratios (HRs). Analyses were performed stratified by sex and by age-group (45–64, 65–74 and ≥75 years of age) with adjustment for age, socio-economic factors and relevant co-morbidities.

Results: During a mean of 5.8 years (standard deviation 2.4) of follow-up, 3954 (32%) patients died (1971 (35%) women, and 1983 (30%) men). High HRs were found for congestive heart disease (CHF) and cerebrovascular diseases for all age-groups among men and women (except for the 45–64 year old women); for coronary heart disease among the oldest men; for diabetes among the 65–74 year old men and the 45–64 year old women. Low HRs were found for hypertension among women ≥75 years of age.

Conclusions: In this clinical setting, CHF and cerebrovascular diseases were consistently associated with mortality in all age-groups. The possible protective effect by hypertension among elderly women should be interpreted with caution.

KEY MESSAGES

• We found congestive heart failure and cerebrovascular diseases to be consistently associated with mortality in both women and men.

• We found hypertension to be associated with lower mortality risk among women ≥75 years of age, although this finding must be interpreted with caution.

• Depression was found to be associated with increased mortality risk among men and women aged 65–74 years of age.

Keywords:

• Coronary heart disease
• cerebrovascular disease
• depression
• congestive heart failure
• gender
• hypertension
• diabetes

Acknowledgements

We thank Patrick Reilly for language editing.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by ALF funding awarded to Jan Sundquist and Kristina Sundquist and by grants from the Swedish Research Council (awarded to Kristina Sundquist), the Swedish Council for Working Life and Social Research (Jan Sundquist), and the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number R01HL116381 to Kristina Sundquist.