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Incident Atrial Fibrillation and the Risk of Congestive Heart Failure, Myocardial Infarction, End-Stage Kidney
David Massicotte-Azarniouch1, John Paul Kuwornu2, Juan-Jesus Carrero3
1Department of Medicine, University of Ottawa, Ottawa, Canada.
Insights
Patients with atrial fibrillation (AF) and reduced kidney function (eGFR < 90mL/min/1.73m²) face significantly higher risks of adverse events, especially within six months of diagnosis. Early interventions are crucial for improving outcomes in this high-risk group.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- The relationship between atrial fibrillation (AF), estimated glomerular filtration rate (eGFR), and adverse events is not well understood.
- Chronic kidney disease is increasingly recognized as a cardiovascular risk factor.
Purpose of the Study:
- To investigate the association between AF and adverse outcomes in patients with reduced eGFR.
- To determine if the risk of adverse events differs in the early versus later periods after AF diagnosis.
Main Methods:
- A population-based retrospective cohort study was conducted using data from Ontario, Canada.
- Included were 1,422,978 adult residents with eGFRs < 90mL/min/1.73m² between 2006 and 2015.
- Propensity score matching was used to compare outcomes between patients with and without AF.
Main Results:
- Adverse events including congestive heart failure (CHF), myocardial infarction (MI), end-stage kidney disease, and all-cause mortality were more frequent in patients with AF.
- The risk was significantly higher within the first 6 months post-diagnosis (e.g., CHF sHR 11.57).
- eGFR level modified the effect of AF on CHF (P for interaction < 0.05).
Conclusions:
- Incident AF is associated with a high risk of adverse outcomes in patients with reduced kidney function (eGFR < 90mL/min/1.73m²).
- The risk is particularly elevated within the first six months after AF diagnosis.
- Timely therapeutic interventions and close monitoring are recommended to improve outcomes.
Background:
The association of atrial fibrillation (AF), estimated glomerular filtration rate (eGFR), and adverse events remains unknown.
Study Design:
Population-based retrospective cohort study from Ontario, Canada.
Setting & Participants:
1,422,978 adult residents with eGFRs < 90mL/min/1.73m2 from April 1, 2006, through March 31, 2015.
Factor:
A diagnosis of AF at hospitalization.
Outcomes:
Congestive heart failure (CHF), myocardial infarction (MI), end-stage kidney disease, all-cause mortality.
Results:
All adverse events were more frequent in individuals with AF (93,414 propensity score matched) compared to no AF, and this difference was more pronounced within the first 6 months of the index date (CHF: 3.04% [AF] vs 0.28% [no AF], subdistribution HR [sHR] of 11.57 [95% CI, 10.26-13.05]; MI: 0.97% [AF] vs 0.21% [no AF], sHR of 4.76 [95% CI, 4.17-5.43]; end-stage kidney disease: 0.16% [AF] vs 0.03% [no AF], sHR of 5.84 [95% CI, 3.82-8.93]; and all-cause mortality: 6.11% [AF] vs 2.50% [no AF], HR of 2.62 [95% CI, 2.50-2.76]) than in the period more than 6 months after the index date (CHF: 6.87% [AF] vs 2.87% [no AF], sHR of 2.64 [95% CI, 2.55-2.74]; MI: 2.21% [AF] vs 1.81% [no AF], sHR of 1.24 [95% CI, 1.18-1.30]; end-stage kidney disease: 0.52% [AF] vs 0.32% [no AF], sHR of 1.75 [95% CI, 1.57-1.95]; and all-cause mortality: 15.55% [AF] vs 15.10% [no AF], HR of 1.07 [95% CI, 1.04-1.10]). The results accounted for the competing risk for mortality. eGFR level modified the effect of AF on CHF (P for interaction < 0.05).
Limitations:
Observational study design does not permit determination of causality; only a single outpatient eGFR measure was used; medication data were not included.
Conclusions:
Incident AF is associated with a high risk for adverse outcomes in patients with eGFRs < 90mL/min/1.73m2. Because the risk is exceedingly high within the first 6 months after AF diagnosis, therapeutic interventions and monitoring may improve outcomes.
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