Abstract 9809: Mortality, Hospitalization, and Cardiac Interventions in Atrial Fibrillation Patients Younger Than 65 Years

Abstract

Introduction: The risk factor burden, and long-term outcome among atrial fibrillation (AF) patients under 65 years of age is unclear. Methods: The study population included 67,221 (mean age 72.4 ± 12.3, 45% female) adult patients with AF evaluated at the University of Pittsburgh Medical Center between 1/2010 and 12/2019. Hospital system wide electronic health records and administrative data using International Classification of Disease 9 and 10 revisions was utilized to ascertain risk factors, comorbidities, and subsequent mortality and hospitalization stratified according to age at initial evaluation. Association of AF with all-cause mortality among those < 65 years was analyzed using an internal contemporary cohort of patients without AF (n=918,073). Results: 17,335 patients (26%) were less than 65 years of age (32% female, 92% white) with considerable cardiovascular risk factors (current smoker 16%, BMI 33.0 ± 8.3, hypertension 55%, Diabetes Mellitus 21%, congestive heart failure 20%, Coronary artery disease 19%, prior ischemic stroke 6%) and comorbidity burden (COPD 11%, Obstructive sleep apnea 18%, CKD 1.3 %). Over mean follow up of > 5 years, 2084 (6.7% <50 years; 13% 50-65 years) patients died. Proportion of patients with >1 hospitalization for MI, HF and Ischemic stroke was 1.25%, 4.8%, and 1.05% for those <50 years and 2.2%,7.4%, and 1.1% for the 50-65 years subgroup respectively. Multiple cardiac and non-cardiac risk factors were associated with increased mortality in younger AF patients with HF and hypertension demonstrating significant age-related interaction (p=0.007 and p=0.013 respectively). AF patients experienced significantly worse survival when compared to comorbidity adjusted patients without AF (Males <50y HR 1.49 (1.24-1.79), 50-65y HR 1.34 (1.26-1.43); Females <50y HR 2.4 (1.82-3.16), 50-65y HR 1.75 (1.6-1.92)). Conclusions: AF patient <65 years of age have significant comorbidity burden and considerable long-term mortality. They are also at a significant increased risk of hospitalization for HF, stroke, and myocardial infarction. Cardiac and non-cardiac comorbidities are independently associated with worse outcome in these patients and warrant aggressive risk factor and comorbidity evaluation and management.