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

Abstract

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.

Figure 1

Cumulative survival plot showing probability of all-cause mortality among self-reported AF participants with different levels of multimorbidity. n = 3651; AF participants (107 excluded due to missing values).

Figure 2

Forest plot of hazard ratio for the presence of different cardiometabolic and non-cardiometabolic conditions and all-cause mortality in participants with AF. n = 3651 (97 excluded due to missing values). Depressive symptoms include PHQ-2 ≥2 Results adjusted for age, sex, socio-economic, smoking, and anticoagulation status. CHD, coronary heart disease; PHQ, Patient Health Questionnaire; PVD, peripheral vascular disease.