Abstract
BackgroundThe global burden of atrial fibrillation (AF) and diabetes mellitus (DM) is constantly rising, leading to an increasing healthcare burden of stroke. AF often remains undiagnosed due to the occurrence in an asymptomatic, silent form, i.e., silent AF (SAF). The study aims to evaluate the relationships between DM and AF prevalence using a mobile long-term continuous ECG telemonitoring vest in a representative Polish and European population ≥ 65 years for detection of AF, symptomatic or silent.MethodsA representative sample of 3014 participants from the cross-sectional NOMED-AF study was enrolled in the analyses (mean age 77.5, 49.1% female): 881 (29.2%) were diagnosed with DM. AF was screened using a telemonitoring vest for a mean of 21.9 ± 9.1days.ResultsOverall, AF was reported in 680 (22.6%) of the whole study population. AF prevalence was higher among subjects with concomitant DM (DM+) versus those without DM (DM−) [25%, 95% CI 22.5-27.8% vs 17%; 95% CI 15.4–18.5% respectively, p < 0.001]. DM patients were commonly associated with SAF [9%; 95% CI 7.9–11.4 vs 7%; 95% CI 5.6–7.5 respectively, p < 0.001], and persistent/permanent AF [12.2%; 95% CI 10.3–14.3 vs 6.9%; 95% CI 5.9–8.1 respectively, p < 0.001] compared to subjects without DM. The prolonged screening was associated with a higher percentage of newly established AF diagnosis in DM+ vs DM− patients (5% vs 4.5% respectively, p < 0.001). In addition to shared risk factors, DM+ subjects were associated with different AF and SAF independent risk factors compared to DM− individuals, including thyroid disease, peripheral/systemic thromboembolism, hypertension, physical activity and prior percutaneous coronary intervention/coronary artery bypass graft surgery.ConclusionsAF affects 1 out of 4 subjects with concomitant DM. The higher prevalence of AF and SAF among DM subjects than those without DM highlights the necessity of active AF screening specific AF risk factors assessment amongst the diabetic population.Trial registration: NCT03243474
Highlights
The global burden of atrial fibrillation (AF) and diabetes mellitus (DM) is constantly rising, leading to an increasing healthcare burden of stroke
The higher prevalence of AF and silent AF (SAF) among DM subjects than those without DM highlights the necessity of active AF screening specific AF risk factors assessment amongst the diabetic population
Multiple studies have reported the association between DM and substantially increased risk of AF incidence [17,18,19,20,21,22]. In this ancillary analysis to NOMED-AF, we aimed to evaluate the relationships between DM and AF prevalence using a mobile long-term continuous ECG telemonitoring vest in a representative Polish population ≥ 65 years for detection of both symptomatic or silent AF
Summary
The global burden of atrial fibrillation (AF) and diabetes mellitus (DM) is constantly rising, leading to an increasing healthcare burden of stroke. The AF prevalence in many prior studies is likely to be underestimated due to many patients with silent AF (SAF), an asymptomatic form of arrhythmia, which remains undiagnosed. The likelihood of establishing the diagnosis increases along with the monitoring timespan [9] These emphasize the necessity of actively searching for AF, preferably taking advantage of non-invasive wearable ECG-monitoring devices, to maintain the balance between efficiency and compliance in predicting rhythm disturbances [10, 11]. In a cross-sectional epidemiological study, the Non-invasive Monitoring for Early Detection of Atrial Fibrillation (NOMED-AF), we investigated the AF prevalence in the European population aged ≥ 65 using long-term continuous monitoring [12]
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