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Multimorbidity and the Risk of Hospitalization and Death in Atrial Fibrillation: A Population-Based Study

Abstract Background Patients with atrial fibrillation (AF) have many comorbidities and excess risks of hospitalization and death. Whether the impact of comorbidities on outcomes is greater in AF than the general population is unknown. Methods 1430 AF patients and community controls matched 1:1 on ag... Full description

Journal Title: The American heart journal 2016, Vol.185, p.74-84
Main Author: Chamberlain, Alanna M
Other Authors: Alonso, Alvaro , Gersh, Bernard J , Manemann, Sheila M , Killian, Jill M , Weston, Susan A , Byrne, Margaret , Roger, Véronique L
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: United States: Elsevier Inc
ID: ISSN: 0002-8703
Link: https://www.ncbi.nlm.nih.gov/pubmed/28267478
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title: Multimorbidity and the Risk of Hospitalization and Death in Atrial Fibrillation: A Population-Based Study
format: Article
creator:
  • Chamberlain, Alanna M
  • Alonso, Alvaro
  • Gersh, Bernard J
  • Manemann, Sheila M
  • Killian, Jill M
  • Weston, Susan A
  • Byrne, Margaret
  • Roger, Véronique L
subjects:
  • Aged
  • Aged, 80 and over
  • Arthritis - epidemiology
  • Article
  • Asthma - epidemiology
  • Atrial fibrillation
  • Atrial Fibrillation - epidemiology
  • Cardiac arrhythmia
  • Cardiovascular
  • Cardiovascular disease
  • Cause of Death
  • Comorbidity
  • Coronary artery
  • Coronary artery disease
  • Coronary Artery Disease - epidemiology
  • Coronary heart disease
  • Death
  • Dementia - epidemiology
  • Diabetes Mellitus - epidemiology
  • Epidemiology
  • Female
  • Fibrillation
  • Health risk assessment
  • Heart diseases
  • Heart Failure - epidemiology
  • Hospitalization
  • Humans
  • Hyperlipidemias - epidemiology
  • Hypertension
  • Hypertension - epidemiology
  • Incidence
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Mental Disorders - epidemiology
  • Middle Aged
  • Minnesota - epidemiology
  • Mortality
  • Multivariate Analysis
  • Neoplasms - epidemiology
  • Obesity - epidemiology
  • Odds Ratio
  • Osteoporosis - epidemiology
  • Patients
  • Population
  • Population studies
  • Proportional Hazards Models
  • Pulmonary Disease, Chronic Obstructive - epidemiology
  • Renal Insufficiency, Chronic - epidemiology
  • Risk
  • Risk Factors
  • Risk taking
  • Smoking
  • Smoking - epidemiology
  • Stroke - epidemiology
ispartof: The American heart journal, 2016, Vol.185, p.74-84
description: Abstract Background Patients with atrial fibrillation (AF) have many comorbidities and excess risks of hospitalization and death. Whether the impact of comorbidities on outcomes is greater in AF than the general population is unknown. Methods 1430 AF patients and community controls matched 1:1 on age and sex were obtained from Olmsted County, Minnesota. Andersen-Gill and Cox regression estimated associations of 19 comorbidities with hospitalization and death, respectively. Results AF cases had a higher prevalence of most comorbidities. Hypertension (25.4%), coronary artery disease (17.7%), and heart failure (13.3%) had the largest attributable risk of AF; these along with obesity and smoking explained 51.4% of AF. Over a mean follow-up of 6.3 years, AF patients experienced higher rates of hospitalization and death than population controls. However, the impact of comorbidities on hospitalization and death was generally not greater in AF patients compared to controls, with the exception of smoking. Ever smokers with AF experienced higher than expected risks of hospitalization and death, with observed vs. expected (assuming additivity of effects) hazard ratios compared to never smokers without AF of 1.78 (1.56–2.02) vs. 1.52 for hospitalization and 2.41 (2.02–2.87) vs. 1.84 for death. Conclusions Patients with AF have a higher prevalence of most comorbidities; however, the impact of comorbidities on hospitalization and death is generally similar in AF and controls. Smoking is a notable exception; ever smokers with AF experienced higher than expected risks of hospitalization and death. Thus, interventions targeting modifiable behaviors may benefit AF patients by reducing their risk of adverse outcomes.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0002-8703
fulltext: fulltext
issn:
  • 0002-8703
  • 1097-6744
url: Link


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titleMultimorbidity and the Risk of Hospitalization and Death in Atrial Fibrillation: A Population-Based Study
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creatorChamberlain, Alanna M ; Alonso, Alvaro ; Gersh, Bernard J ; Manemann, Sheila M ; Killian, Jill M ; Weston, Susan A ; Byrne, Margaret ; Roger, Véronique L
creatorcontribChamberlain, Alanna M ; Alonso, Alvaro ; Gersh, Bernard J ; Manemann, Sheila M ; Killian, Jill M ; Weston, Susan A ; Byrne, Margaret ; Roger, Véronique L
descriptionAbstract Background Patients with atrial fibrillation (AF) have many comorbidities and excess risks of hospitalization and death. Whether the impact of comorbidities on outcomes is greater in AF than the general population is unknown. Methods 1430 AF patients and community controls matched 1:1 on age and sex were obtained from Olmsted County, Minnesota. Andersen-Gill and Cox regression estimated associations of 19 comorbidities with hospitalization and death, respectively. Results AF cases had a higher prevalence of most comorbidities. Hypertension (25.4%), coronary artery disease (17.7%), and heart failure (13.3%) had the largest attributable risk of AF; these along with obesity and smoking explained 51.4% of AF. Over a mean follow-up of 6.3 years, AF patients experienced higher rates of hospitalization and death than population controls. However, the impact of comorbidities on hospitalization and death was generally not greater in AF patients compared to controls, with the exception of smoking. Ever smokers with AF experienced higher than expected risks of hospitalization and death, with observed vs. expected (assuming additivity of effects) hazard ratios compared to never smokers without AF of 1.78 (1.56–2.02) vs. 1.52 for hospitalization and 2.41 (2.02–2.87) vs. 1.84 for death. Conclusions Patients with AF have a higher prevalence of most comorbidities; however, the impact of comorbidities on hospitalization and death is generally similar in AF and controls. Smoking is a notable exception; ever smokers with AF experienced higher than expected risks of hospitalization and death. Thus, interventions targeting modifiable behaviors may benefit AF patients by reducing their risk of adverse outcomes.
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subjectAged ; Aged, 80 and over ; Arthritis - epidemiology ; Article ; Asthma - epidemiology ; Atrial fibrillation ; Atrial Fibrillation - epidemiology ; Cardiac arrhythmia ; Cardiovascular ; Cardiovascular disease ; Cause of Death ; Comorbidity ; Coronary artery ; Coronary artery disease ; Coronary Artery Disease - epidemiology ; Coronary heart disease ; Death ; Dementia - epidemiology ; Diabetes Mellitus - epidemiology ; Epidemiology ; Female ; Fibrillation ; Health risk assessment ; Heart diseases ; Heart Failure - epidemiology ; Hospitalization ; Humans ; Hyperlipidemias - epidemiology ; Hypertension ; Hypertension - epidemiology ; Incidence ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Mental Disorders - epidemiology ; Middle Aged ; Minnesota - epidemiology ; Mortality ; Multivariate Analysis ; Neoplasms - epidemiology ; Obesity - epidemiology ; Odds Ratio ; Osteoporosis - epidemiology ; Patients ; Population ; Population studies ; Proportional Hazards Models ; Pulmonary Disease, Chronic Obstructive - epidemiology ; Renal Insufficiency, Chronic - epidemiology ; Risk ; Risk Factors ; Risk taking ; Smoking ; Smoking - epidemiology ; Stroke - epidemiology
ispartofThe American heart journal, 2016, Vol.185, p.74-84
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7Roger, Véronique L
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descriptionAbstract Background Patients with atrial fibrillation (AF) have many comorbidities and excess risks of hospitalization and death. Whether the impact of comorbidities on outcomes is greater in AF than the general population is unknown. Methods 1430 AF patients and community controls matched 1:1 on age and sex were obtained from Olmsted County, Minnesota. Andersen-Gill and Cox regression estimated associations of 19 comorbidities with hospitalization and death, respectively. Results AF cases had a higher prevalence of most comorbidities. Hypertension (25.4%), coronary artery disease (17.7%), and heart failure (13.3%) had the largest attributable risk of AF; these along with obesity and smoking explained 51.4% of AF. Over a mean follow-up of 6.3 years, AF patients experienced higher rates of hospitalization and death than population controls. However, the impact of comorbidities on hospitalization and death was generally not greater in AF patients compared to controls, with the exception of smoking. Ever smokers with AF experienced higher than expected risks of hospitalization and death, with observed vs. expected (assuming additivity of effects) hazard ratios compared to never smokers without AF of 1.78 (1.56–2.02) vs. 1.52 for hospitalization and 2.41 (2.02–2.87) vs. 1.84 for death. Conclusions Patients with AF have a higher prevalence of most comorbidities; however, the impact of comorbidities on hospitalization and death is generally similar in AF and controls. Smoking is a notable exception; ever smokers with AF experienced higher than expected risks of hospitalization and death. Thus, interventions targeting modifiable behaviors may benefit AF patients by reducing their risk of adverse outcomes.
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12Coronary artery
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14Coronary Artery Disease - epidemiology
15Coronary heart disease
16Death
17Dementia - epidemiology
18Diabetes Mellitus - epidemiology
19Epidemiology
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21Fibrillation
22Health risk assessment
23Heart diseases
24Heart Failure - epidemiology
25Hospitalization
26Humans
27Hyperlipidemias - epidemiology
28Hypertension
29Hypertension - epidemiology
30Incidence
31Kaplan-Meier Estimate
32Logistic Models
33Male
34Mental Disorders - epidemiology
35Middle Aged
36Minnesota - epidemiology
37Mortality
38Multivariate Analysis
39Neoplasms - epidemiology
40Obesity - epidemiology
41Odds Ratio
42Osteoporosis - epidemiology
43Patients
44Population
45Population studies
46Proportional Hazards Models
47Pulmonary Disease, Chronic Obstructive - epidemiology
48Renal Insufficiency, Chronic - epidemiology
49Risk
50Risk Factors
51Risk taking
52Smoking
53Smoking - epidemiology
54Stroke - epidemiology
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authorChamberlain, Alanna M ; Alonso, Alvaro ; Gersh, Bernard J ; Manemann, Sheila M ; Killian, Jill M ; Weston, Susan A ; Byrne, Margaret ; Roger, Véronique L
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9Cardiovascular disease
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abstractAbstract Background Patients with atrial fibrillation (AF) have many comorbidities and excess risks of hospitalization and death. Whether the impact of comorbidities on outcomes is greater in AF than the general population is unknown. Methods 1430 AF patients and community controls matched 1:1 on age and sex were obtained from Olmsted County, Minnesota. Andersen-Gill and Cox regression estimated associations of 19 comorbidities with hospitalization and death, respectively. Results AF cases had a higher prevalence of most comorbidities. Hypertension (25.4%), coronary artery disease (17.7%), and heart failure (13.3%) had the largest attributable risk of AF; these along with obesity and smoking explained 51.4% of AF. Over a mean follow-up of 6.3 years, AF patients experienced higher rates of hospitalization and death than population controls. However, the impact of comorbidities on hospitalization and death was generally not greater in AF patients compared to controls, with the exception of smoking. Ever smokers with AF experienced higher than expected risks of hospitalization and death, with observed vs. expected (assuming additivity of effects) hazard ratios compared to never smokers without AF of 1.78 (1.56–2.02) vs. 1.52 for hospitalization and 2.41 (2.02–2.87) vs. 1.84 for death. Conclusions Patients with AF have a higher prevalence of most comorbidities; however, the impact of comorbidities on hospitalization and death is generally similar in AF and controls. Smoking is a notable exception; ever smokers with AF experienced higher than expected risks of hospitalization and death. Thus, interventions targeting modifiable behaviors may benefit AF patients by reducing their risk of adverse outcomes.
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