Association between cardiometabolic comorbidity and mortality in patients with atrial fibrillation

Abstract

Background: Patients with atrial fibrillation (AF) often suffer from cardiometabolic comorbidities, but the impact of the type and number of cardiometabolic comorbidities on the prognosis of AF patients remain unclear. Methods: From August 2011 to December 2018, 23,838 AF patients from the Chinese Atrial Fibrillation Registry (China-AF) Study were enrolled in this study. The all-cause and cardiovascular-cause mortality was described. The Cox proportional hazard model was employed to explore the associations of the type and number of cardiometabolic comorbidities with all-cause and cardiovascular-cause mortality. Results: During an average follow-up of 4.07 ± 1.96 years, 2,140 (8.98%) deaths were identified. The mortality in AF patients with cardiometabolic conditions was significantly higher than that in AF patients without cardiometabolic conditions. Cardiovascular events contributed the most to the death of AF patients, particularly heart failure. AF complicated with heart failure was associated with the highest risk of all-cause mortality [hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.74–2.13], followed by thromboembolism, diabetes mellitus, and vascular diseases. Whereas, the presence of co-morbid hypertension did not have a significant association with all-cause mortality (HR 0.97, 95%CI 0.86–1.09). The adjusted HRs for all-cause mortality in AF patients were 1.21 (95%CI 0.99–1.47), 1.71 (95%CI 1.40–2.08), 2.55 (95%CI 2.07–3.13), and 3.39 (95%CI 2.71–4.24) for 1, 2, 3, and ≥ 4 cardiometabolic comorbidities, respectively. Conclusion: The increase in the number of cardiometabolic comorbidities is associated with mortality in AF patients. Hence, strengthening the management of cardiometabolic comorbidities is critical to reducing the mortality of patients with AF. Trial Registration: URL: http://www.chictr.org.cn/showproj.aspx?proj=5831. Registration number: ChiCTR-OCH-13003729. Date of the registration is October 22, 2013.