Atrial Fibrillation and Declining Physical Performance in Older Adults: The Health, Aging, and Body Composition Study

Abstract

Background: Age is the foremost risk factor for atrial fibrillation (AF), and AF has a rising prevalence in older adults. How AF may contribute to decline in physical performance in older adults has had limited investigation. We examined the associations of incident AF and 4-year interval declines in physical performance at ages 70, 74, 78, and 82 years in the Health, Aging, and Body Composition (Health ABC) Study.

Methods and results: Health ABC is a prospective cohort of community-dwelling older adults (n=3075). The study conducted serial assessments of physical performance with the Health ABC physical performance battery (scored 0-4), grip strength, 2-minute walk distance, and 400-m walking time. Incident AF was identified from the Center for Medicare and Medicaid Services and related to 4-year interval decline in physical performance. After exclusions, the analysis included 2753 Health ABC participants (52% women, 41% black race). Participants with AF had a significantly greater 4-year physical performance battery decline than those without AF at age 70, 74, 78, and 82, with mean estimated decline ranging from -0.08 to -0.10 U (95% confidence interval, -0.18 to -0.01; P<0.05 for all estimates) after multivariable adjustment. Grip strength, walk distance, and walk time similarly showed significantly greater declines at each 4-year age interval in participants with AF.

Conclusions: In community-based cohort older adults, incident AF was associated with increased risk of decline in physical performance. Further research is essential to identify mechanisms and preventive strategies for how AF may contribute toward declining physical performance in older adults.

Keywords: aging; atrial fibrillation; epidemiology; medicare; physical exercise.

Figure 1

Model predicted trajectory of mean Health ABC physical performance battery scores. The 4-year decline in Health ABC participants’ physical performance battery at ages 70, 74, 78, and 82 years, comparing participants with incident atrial fibrillation (red-dashed line) and those without (blue solid line; shaded, 95% confidence intervals).

Figure 2

Proposed relation between atrial fibrillation, loss of physical performance capacity and functional status, and morbidity in older adults. The figure shows proposed pathways relating atrial fibrillation – with augmented risk in older adults with cardiovascular disease and its risk factors – to loss of atrial mechanics and decreased ventricular function. Heart failure, stroke, and decreased atrial function may contribute towards the decline in physical performance as observed in our analysis. Poor physical performance and functional status in older adults have been related to declining mobility, loss of independence, cognitive decline, disability, institutionalization, and increased mortality.