Trajectories of walking speed in older adults with atrial fibrillation: a 15 year-follow-up population-based study

Abstract

Abstract Background Atrial fibrillation (AF), the most common arrhythmia in older adults, has been associated with frailty. However, the role exerted by AF in the long-term trajectories of functional decline still needs to be elucidated. Purpose The aim of the present study was to evaluate AF clinical impact on functional decline by tracing the evolution of the walking speed (WS) over 15 years of follow-up in a population-based cohort of older individuals. Methods This population-based cohort study included 3141 non-institutionalized participants (age ≥60 years; 63.6% women) from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) carried out in Stockholm, who were regularly examined from 2001–2004 to 2016-2019. AF was ascertained from clinical examination, electrocardiogram, and the Swedish National Patient Registry. Physical decline was assessed measuring participants mobility through the WS test (m/s). Participants WS was evaluated at baseline, and then followed up every 6 years (those aged <78 years) or every 3 years (those aged ≥78 years). Incident heart failure, stroke and dementia were also recorded during the follow-up visits. The association between AF and WS trajectories was tested by multivariable joint models accounting for the longitudinal dropouts due to death. Analyses were also stratified by relevant individual characteristics after adjustment for clinically relevant covariates. Results At baseline, 285 (9.1%) participants were ascertained to have prevalent AF. Upon accounting for several potential confounders, we observed a faster annual WS decline in AF participants than in non-AF peers (β coefficient per year = −0.013, 95% confidence interval [CI]: −0.017 to −0.007) after multivariable adjustment for age, sex, education, dementia, COPD, diabetes, hypertension, heart failure, stroke, physical activity levels and BMI. The association was stronger in individuals 78+ than those younger than 78 years and in those without stroke, heart failure and higher engagement in physical activity (p per interaction <0.05). In a secondary analysis carried out among participants who were free of heart failure, stroke, and dementia at baseline, controlling by incident heart failure, incident stroke, and incident dementia did not attenuate the association between AF and WS change. Conclusion AF is independently associated with a faster physical performance decline in older individuals Incident stroke, heart failure or dementia don’t seem to mediate the relationship between AF and mobility decline over time.