Abstract 127: Differences in Care Patterns, Health Status, and Outcomes of Atrial Fibrillation in Patients With and Without Diabetes: Findings From the ORBIT-AF Registry
Objective: Diabetes is a common among patients with atrial fibrillation (AF). However, little is known on the impact of diabetes on symptoms, health status, care and outcomes among AF patients. We assessed whether symptoms, health status, care and outcomes differ between AF patients with and without diabetes.
Methods: This observational cohort study included 9,749 patients with AF from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation registry, a prospective, nationwide, multicenter outpatient registry of patients with incident and prevalent AF enrolled at 174 sites between June 2010 and August 2011. The outcomes were symptoms, health status, and AF treatment, as well as 2-year risks of death, readmission, thrombomebolic events, heart failure (HF) and AF progression.
Results: Among AF patients; those with diabetes (29.5%) were younger and more likely to have hypertension, chronic kidney disease, HF, coronary heart disease, and stroke. Patients with diabetes had a lower Atrial Fibrillation Effects on Quality of Life score (80.6 [IQR: 62.5 - 92.6] vs. 82.4 [IQR: 67.6 -93.5]; P= 0.025), but a higher CHA2DS2-VASc score (5 [IQR: 4 - 6] vs. 4 [2 - 5]; P<0.0001) and were more likely to receive anticoagulation (P<0.001). Diabetes was associated with higher mortality, with a greater overall (adjusted hazard ratio [aHR]: 1.63 [95% CI: 1.04-2.56] for age<70 vs. 1.25 [1.09-1.44] for age ≥70) and cardiovascular (2.20 [1.22-3.98] for age<70 vs. 1.24 [1.02-1.51] for age ≥70) mortality risks before age 70 years. Diabetes conferred a higher risk of non-cardiovascular (CV) death (1.29 [1.06-1.56]), sudden cardiac death (1.53 [1.04-2.26]), hospitalization (1.15 [1.09-1.22]), CV hospitalization (1.13 [1.05-1.22]) and non-CV and non-bleeding-related hospitalization (1.19 [1.10-1.30]); but no increase in risks of thromboembolic events, bleeding related hospitalization, new-onset HF, and AF progression. The use of oral anticoagulants (OAC) modifies the relation of diabetes and all-cause hospitalization, with a higher risk among those on OAC (1.21 [1.12-1.29]).
Conclusions: Among patients with AF, diabetes was associated with worse AF symptoms and lower quality of life, as well an increased risk of death and hospitalizations, but not with the risk of thromboembolic or bleeding events.
Author Disclosures: J.B. Echouffo Tcheugui: None. P. Shrader: None. L. Thomas: None. B.J. Gersh: E. Honoraria; Modest; Mount Sinai–St Luke’s, Boston Scientific Corp, Teva Pharmaceuticals, Janssen Scientific Affairs, St Jude Medical, Baxter Healthcare Corp, Cardiovascular Research Foundation, Medtronic, and Xenon. P. Kowey: E. Honoraria; Modest; Johnson & Johnson. K.W. Mahaffey: None. D.E. Singer: None. E.M. Hylek: E. Honoraria; Modest; Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Janssen, Medtronic, Pfizer, and Portola. A.S. Go: None. E.D. Peterson: B. Research Grant; Modest; Eli Lilly & Co and Janssen Scientific Affairs.. G. Consultant/Advisory Board; Modest; Boehringer Ingelheim, Sanofi, AstraZeneca, Valeant, Bayer, and Janssen. J.P. Piccini: B. Research Grant; Modest; Janssen Pharmaceuticals. C. Other Research Support; Modest; ARCA Biopharma, Boston Scientific, GE Healthcare, and Johnson & Johnson/Janssen Scientific Affairs. G. Consultant/Advisory Board; Modest; Bristol-Myers Squibb/Pfizer, Johnson & Johnson, Forest Laboratories, Janssen Scientific Affairs, Spectranetics, and Medtronic. G.C. Fonarow: G. Consultant/Advisory Board; Modest; Novartis, Amgen, Bayer, Gambro, Medtronic, and Janssen.
- © 2017 by American Heart Association, Inc.