Resumen de Incident Atrial Fibrillation and Disability: Free Survival in the Cardiovascular Health Study
Erin R. Wallace, David Siscovick, Colleen M. Sitlani, Sascha Dublin, Pamela H. Mitchell, Michelle C. Odden, Calvin H. Hirsch, Stephen Thielke, Susan R. Heckbert
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.
