Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Evangelos Akrivos,Georgios Kotzampasis,Evangelos Liampas,Andreas S. Papazoglou,Anastasios Papanastasiou,Apostolos Tzikas,Eleni Vrana,Athanasios Samaras,George Giannakoulas,Amalia Baroutidou,Anastasios Kartas,Michail Botis,Efstratios Karagiannidis,Nikolaos Stalikas,Dimitrios V. Moysidis,Haralambos Karvounis,Ioannis Vouloagkas

doi:10.1186/s12933-021-01232-7

Abstract

BackgroundThere are limited data on the association of diabetes mellitus (DM) and levels of glycated hemoglobin (HbA1c) with outcomes in patients with atrial fibrillation (AF).MethodsThis retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 2018. Kaplan–Meier curves and Cox-regression adjusted hazard ratios (aHR) were calculated for the primary outcome of all-cause mortality and for the secondary outcomes of cardiovascular (CV) mortality and the composite outcome of CV death or hospitalization. Competing-risk regression analyses were performed to calculate the cumulative risk of stroke, major bleeding, AF- or HF-hospitalizations adjusted for the competing risk of all-cause death. Spline curve models were fitted to investigate associations of HbA1c values and mortality among patients with AF and DM.ResultsIn total 1109 AF patients were included, of whom 373 (33.6%) had DM. During a median follow-up of 2.6 years, 414 (37.3%) patients died. The presence of DM was associated with a higher risk of all-cause mortality (aHR = 1.40 95% confidence intervals [CI] 1.11–1.75), CV mortality (aHR = 1.39, 95% CI 1.07–1.81), sudden cardiac death (aHR = 1.73, 95% CI 1.19–2.52), stroke (aHR = 1.87, 95% CI 1.01–3.45) and the composite outcome of hospitalization or CV death (aHR = 1.27, 95% CI 1.06–1.53). In AF patients with comorbid DM, the spline curves showed a positive linear association between HbA1c levels and outcomes, with values 7.6–8.2% being independent predictors of increased all-cause mortality, and values < 6.2% predicting significantly decreased all-cause and CV mortality.ConclusionsThe presence of DM on top of AF was associated with substantially increased risk for all-cause or CV mortality, sudden cardiac death and excess morbidity. HbA1c levels lower than 6.2% were independently related to better survival rates suggesting that optimal DM control could be associated with better clinical outcomes in AF patients with DM.

Highlights

There are limited data on the association of diabetes mellitus (DM) and levels of glycated hemoglobin (HbA1c) with outcomes in patients with atrial fibrillation (AF)
We examined the association of DM and blood glucose regulation, as mirrored by the levels of glycated hemoglobin, with the clinical outcomes of patients with AF
DM was significantly associated with the prevalence of other medical conditions, such as hypertension, dyslipidemia, chronic obstructive pulmonary disease, heart failure (HF), stroke, myocardial infarction, vascular and chronic kidney disease

Summary

Introduction

There are limited data on the association of diabetes mellitus (DM) and levels of glycated hemoglobin (HbA1c) with outcomes in patients with atrial fibrillation (AF). Both atrial fibrillation (AF) and diabetes mellitus (DM) are medical conditions that nowadays affect western populations at an epidemic rate. These diseases have both evolved into a severe health threat and a costly global health burden. The relation between AF and DM still remains a promising field of study, because of the growing evidence that their concomitance affects and perplexes clinical outcomes. Despite the plethora of studies on AF and DM, there is still no sufficient data on the blood glucose regulation as a prognostic modifier in DM patients with AF

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