Management and prognosis of atrial fibrillation in the diabetic patient

Abstract

The global burden of atrial fibrillation and diabetes mellitus (diabetes) is considerable, and prevalence rates are increasing. Diabetes is associated with an increased risk of developing atrial fibrillation; however, diabetes also influences the management and prognosis of atrial fibrillation. In the following article, the authors describe the association between diabetes and atrial fibrillation; specifically, the significance of diabetes on the risk of atrial fibrillation, ischemic stroke and bleeding complications associated with anticoagulation. In addition, the authors evaluate the risks and outcomes of heart failure and the success rates of both ablation and cardioversion in atrial fibrillation patients with diabetes. Finally, this article describes the association of HbA1c levels with the management and prognosis of atrial fibrillation patients.

Keywords:

• ablation
• atrial fibrillation
• bleeding
• cardioversion
• diabetes mellitus
• HbA1c
• heart failure
• novel oral anticoagulants
• stroke

Financial & competing interests disclosure

JL Pallisgaard, TB Lindhardt, JB Olesen and ML Hansen participated in a study funded by an unrestricted research grant from Boehringer-Ingelheim. GH Gislason is supported by an unrestricted clinical research scholarship from the Novo Nordisk Foundation and Boehringer-Ingelheim. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• There is strong evidence of an association between diabetes and atrial fibrillation.

• Increased HbA1c levels are associated with increased risk of developing atrial fibrillation, but strict glucose control has yet to prove beneficial.

• Prevalent diabetes and increased HbA1c levels increases the risk of stroke in patients with atrial fibrillation.

• Novel oral anticoagulants perform better in stroke risk reduction than warfarin, in patients with atrial fibrillation and diabetes.

• Although not recognized in the HAS-BLED score, there is strong evidence that diabetes increases the risk of bleeding during anticoagulation therapy.

• There is conflicting evidence regarding the role of diabetes and chance of recurrent atrial fibrillation after cardioversion.

• Success rates with ablation are influenced by diabetes status and HbA1c levels.

• Patients with diabetes and heart failure have a high risk of stroke when undergoing cardioversion without anticoagulation.

• Atrial fibrillation is associated with increased risk of developing heart failure in patients with diabetes.