Incident Atrial Fibrillation and Disability: Free Survival in the Cardiovascular Health Study
- Autores: Erin R. Wallace, David Siscovick, Colleen M. Sitlani, Sascha Dublin, Pamela H. Mitchell, Michelle C. Odden, Calvin H. Hirsch, Stephen Thielke, Susan R. Heckbert
- Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 64, Nº. 4, 2016, págs. 838-843
- Idioma: inglés
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Resumen
Objectives To assess the associations between incident atrial fibrillation (AF) and disability-free survival and risk of disability.
Design Prospective cohort study.
Setting Cardiovascular Health Study.
Participants Individuals aged 65 and older and enrolled in fee-for-service Medicare followed between 1991 and 2009 (MN = 4,046). Individuals with prevalent AF, activity of daily living (ADL) disability, or a history of stroke or heart failure at baseline were excluded.
Measurements Incident AF was identified according to annual study electrocardiogram, hospital discharge diagnosis, or Medicare claims. Disability-free survival was defined as survival free of ADL disability (any difficulty or inability in bathing, dressing, eating, using the toilet, walking around the home, or getting out of a bed or chair). ADLs were assessed at annual study visits or in a telephone interview. Association between incident AF and disability-free survival or risk of disability was estimated using Cox proportional hazards models.
Results Over an average of 7.0 years of follow-up, 660 individuals (16.3%) developed incident AF, and 3,112 (77%) became disabled or died. Incident AF was associated with shorter disability-free survival (hazard ratio (HR) for death or ADL disability = 1.71, 95% confidence interval (CI) = 1.55–1.90) and a higher risk of ADL disability (HR = 1.36, 95% CI = 1.18–1.58) than in individuals with no history of AF. This association persisted after adjustment for interim stroke and heart failure.
Conclusion These results suggest that AF is a risk factor for shorter functional longevity in older adults, independent of other risk factors and comorbid conditions.
