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Published on: February 26, 2013
Investigating the Association Between Atrial Fibrillation and Out-of-Hospital Cardiac Arrest: A Danish Nationwide
Deepthi Rajan1, Tobias Skjelbred1, Peder E Warming1
1Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Insights
Atrial fibrillation (AF) increases the risk of out-of-hospital cardiac arrest (OHCA), even when accounting for heart disease. This finding highlights AF as a significant risk factor for OHCA and mortality.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Atrial fibrillation (AF) is a growing global health concern.
- Out-of-hospital cardiac arrest (OHCA) has a high mortality rate.
- Shared risk factors like ischemic heart disease complicate the AF-OHCA link.
Purpose of the Study:
- To investigate the association between atrial fibrillation (AF) and out-of-hospital cardiac arrest (OHCA).
- To analyze this association considering risk factors for ischemic heart disease and heart failure.
Main Methods:
- Nationwide Danish cohort study (2001-2022) of individuals aged 18-85.
- Matched 1:4 cohort of AF patients and non-AF patients based on shared risk factors.
- Multivariable Cox regression to assess hazard ratios for OHCA and all-cause mortality.
Main Results:
- Included over 309,010 AF patients matched with 1,236,040 non-AF patients.
- AF patients had significantly higher adjusted hazard ratios for OHCA (1.66) and all-cause mortality (1.79).
Conclusions:
- Atrial fibrillation is an independent risk factor for OHCA.
- Further research should identify high-risk AF patient subsets for targeted prevention strategies.
Background:
Atrial fibrillation (AF) is an impending global epidemic, and out-of-hospital cardiac arrest (OHCA) is associated with high mortality. Although emerging evidence links AF with OHCA, research has been challenged by shared risk factors, especially ischemic heart disease and heart failure.
Objectives:
This study aimed to investigate the association between AF and OHCA in light of risk factors for ischemic heart disease and heart failure.
Methods:
This was a Danish, nationwide matched cohort study using the Danish Cardiac Arrest Registry (June 1, 2001, to December 31, 2022) in individuals aged 18 to 85 years. Exposure was an AF diagnosis, and outcomes were OHCA and all-cause mortality. A 1:4 matching of AF patients with non-AF patients upon sex, birth year, ischemic heart disease, heart failure, diabetes, cancer, hypertrophic cardiomyopathy, dilated cardiomyopathy, and statin usage was performed. Multivariable Cox regression models were used and results presented as cumulative incidences from time of AF diagnosis/matching and HRs of OHCA and all-cause mortality.
Results:
The study included 6.47 million individuals, of whom 368,639 had AF. A total of 309,010 patients with AF (only newly diagnosed in the time period) were matched to 1,236,040 non-AF patients. Adjusted HRs of OHCA and all-cause mortality were higher in AF patients vs non-AF patients (1.66 [95% CI: 1.62-1.70] and 1.79 [95% CI: 1.78-1.81], respectively).
Conclusions:
Findings suggest that AF remains a risk factor for OHCA, even after adjustments for ischemic heart disease and heart failure. Future studies should explore subsets of patients with AF at highest risk of OHCA to tailor preventive efforts toward this patient group.
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