Multimorbidity and risk of atrial fibrillation in the Lifelines cohort

Associations of individual comorbidities with incident atrial fibrillation (AF) are well-studied. However, the impact of multimorbidity and potentially clustering of comorbidities on incident AF remains unclear. This study investigated the number and clustering of (non-)cardiovascular comorbidities with incident AF.

We studied 25 (non-)cardiovascular comorbidities in 76 648 participants from the Lifelines cohort. Logistic regression was used to study the association between the number of comorbidities and incident AF. Latent class analysis was used to identify comorbidity clusters. Mean age was 46.4 ± 2.6 years and 59.3% were women. In this population, 56 034 (73.1%) participants had ≥2 comorbidities, 42 575 (55.5%) ≥ 2 cardiovascular comorbidities, and 14 612 (19.1%) ≥ 2 non-cardiovascular comorbidities. After a mean follow-up of 3.70 ± 0.95 years, 188 (0.2%) participants developed incident AF. After adjusting for age and sex, the total number of comorbidities (OR 1.10 [1.01-1.19], P = 0.022) and number of cardiovascular comorbidities (OR 1.18 [1.06-1.31], P = 0.002) were associated with incident AF, but not the number of non-cardiovascular comorbidities. We identified 12 comorbidity clusters carrying different risks of incident AF (AF incidence rate range 0.00 to 0.58 per 100 person-years, P < 0.001) with the median number of comorbidities ranging from one to seven. However, the clusters did not demonstrate specific combinations of comorbidities.

There was a dose-dependent relationship between the number of total comorbidities and cardiovascular comorbidities and risk of incident AF, but not for non-cardiovascular comorbidities. We identified 12 comorbidity clusters with different risks of incident AF; however, these clusters were determined by the number of comorbidities rather than specific combinations.