Multimorbidity and co-morbidity in atrial fibrillation and effects on survival: findings from UK Biobank cohort

Jani, B. D. , Nicholl, B. I. , McQueenie, R., Connelly, D. T., Hanlon, P. , Gallacher, K. I. , Lee, D. and Mair, F. S. (2018) Multimorbidity and co-morbidity in atrial fibrillation and effects on survival: findings from UK Biobank cohort. Europace, 20, f329-f336. (doi: 10.1093/europace/eux322) (PMID:29112751) (PMCID:PMC6277149)

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Aims: To examine the number and type of co-morbid long-term health conditions (LTCs) and their associations with all-cause mortality in an atrial fibrillation (AF) population. Methods and results: Community cohort participants (UK Biobank n = 502 637) aged 37–73 years were recruited between 2006 and 2010. Self-reported LTCs (n = 42) identified in people with AF at baseline. All-cause mortality was available for a median follow-up of 7 years (interquartile range 76–93 months). Hazard ratios (HRs) examined associations between number and type of co-morbid LTC and all-cause mortality, adjusting for age, sex, socio-economic status, smoking, and anticoagulation status. Three thousand six hundred fifty-one participants (0.7% of the study population) reported AF; mean age was 61.9 years. The all-cause mortality rate was 6.7% (248 participants) at 7 years. Atrial fibrillation participants with ≥4 co-morbidities had a six-fold higher risk of mortality compared to participants without any LTC. Co-morbid heart failure was associated with higher risk of mortality [HR 2.96, 95% confidence interval (CI) 1.83–4.80], whereas the presence of co-morbid stroke did not have a significant association. Among non-cardiometabolic conditions, presence of chronic obstructive pulmonary disease (HR 3.31, 95% CI 2.14–5.11) and osteoporosis (HR 3.13, 95% CI 1.63–6.01) was associated with a higher risk of mortality. Conclusion: Survival in middle-aged to older individuals with self-reported AF is strongly correlated with level of multimorbidity. This group should be targeted for interventions to optimize their management, which in turn may potentially reduce the impact of their co-morbidities on survival. Future AF clinical guidelines need to place greater emphasis on the issue of co-morbidity.

Item Type:Articles
Additional Information:This work was supported by funding from the Chief Scientist Office, Scotland Catalyst grant (CGA/16/39) and a NHS Research Scotland Career Researcher Fellowship.
Glasgow Author(s) Enlighten ID:Jani, Dr Bhautesh and Gallacher, Dr Katie and Lee, Professor Duncan and Mair, Professor Frances and Nicholl, Dr Barbara and Connelly, Dr Derek and McQueenie, Dr Ross and Hanlon, Dr Peter
Authors: Jani, B. D., Nicholl, B. I., McQueenie, R., Connelly, D. T., Hanlon, P., Gallacher, K. I., Lee, D., and Mair, F. S.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
College of Science and Engineering > School of Mathematics and Statistics > Statistics
Journal Name:Europace
Publisher:Oxford University Press
ISSN (Online):1532-2092
Published Online:02 November 2017
Copyright Holders:Copyright © 2017 The Authors
First Published:First published in Europace 20:f329–f336
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
756022Multimorbidity in UK BiobankBarbara NichollOffice of the Chief Scientist (CSO)CGA/16/39IHW - GENERAL PRACTICE & PRIMARY CARE