Association of Diabetes With Atrial Fibrillation Phenotype and Cardiac and Neurological Comorbidities: Insights From the Swiss-AF Study

of the Swiss‐Investigators

doi:10.1161/JAHA.121.021800

Association of Diabetes With Atrial Fibrillation Phenotype and Cardiac and Neurological Comorbidities: Insights From the Swiss-AF Study

of the Swiss‐Investigators

Clinical sciences

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Abstract

Background Diabetes is a major risk factor for atrial fibrillation (AF). However, it remains unclear whether individual AF phenotype and related comorbidities differ between patients who have AF with and without diabetes. This study investigated the association of diabetes with AF phenotype and cardiac and neurological comorbidities in patients with documented AF. Methods and Results Participants in the multicenter Swiss-AF (Swiss Atrial Fibrillation) study with data on diabetes and AF phenotype were eligible. Primary outcomes were parameters of AF phenotype, including AF type, AF symptoms, and quality of life (assessed by the European Quality of Life-5 Dimensions Questionnaire [EQ-5D]). Secondary outcomes were cardiac (ie, history of hypertension, myocardial infarction, and heart failure) and neurological (ie, history of stroke and cognitive impairment) comorbidities. The cross-sectional association of diabetes with these outcomes was assessed using logistic and linear regression, adjusted for age, sex, and cardiovascular risk factors. We included 2411 patients with AF (27.4% women; median age, 73.6 years). Diabetes was not associated with nonparoxysmal AF (odds ratio [OR], 1.01; 95% CI, 0.81-1.27). Patients with diabetes less often perceived AF symptoms (OR, 0.74; 95% CI, 0.59-0.92) but had worse quality of life (β=-4.54; 95% CI, -6.40 to -2.68) than those without diabetes. Patients with diabetes were more likely to have cardiac (hypertension [OR, 3.04; 95% CI, 2.19-4.22], myocardial infarction [OR, 1.55; 95% CI, 1.18-2.03], heart failure [OR, 1.99; 95% CI, 1.57-2.51]) and neurological (stroke [OR, 1.39, 95% CI, 1.03-1.87], cognitive impairment [OR, 1.75, 95% CI, 1.39-2.21]) comorbidities. Conclusions Patients who have AF with diabetes less often perceive AF symptoms but have worse quality of life and more cardiac and neurological comorbidities than those without diabetes. This raises the question of whether patients with diabetes should be systematically screened for silent AF. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02105844.

Original language	English
Article number	e021800
Number of pages	23
Journal	Journal of the American Heart Association
Volume	10
Issue number	22
DOIs	https://doi.org/10.1161/JAHA.121.021800
Publication status	Published - 16 Nov 2021

Bibliographical note

Funding Information:
David Conen holds a McMaster University Department of Medicine Mid-Career Research Award, and has received speaker fees from Servier Canada, outside of the submitted work. Nicolas Rodondi received a grant from the Swiss Heart Foundation. Jürg H. Beer reports grants from the Swiss National Foundation of Science and The Swiss Heart Foundation; grants from Bayer; and lecture fees from Sanofi Aventis and Amgen, to the institution outside the submitted work. Giorgio Moschovitis has received consultant fees for taking part in advisory boards from Novartis, Astra Zeneca, Bayer, and Böhringer Ingelheim, outside of the submitted work. Giulio Conte reports a research grant from the Swiss National Science Foundation, and research grants from Boston Scientific Inc. Christian Sticherling has received speaker honoraria from Biosense Webster, Boston Scientific, and Medtronic; and research grants from Biosense Webster, Daiichi-Sankyo, and Medtronic. He is a proctor for Medtronic (Cryoballoon). Christine S. Zuern reports a research grant from Medtronic and speaker fees from Vifor Pharma and Novartis. Michael Kühne reports personal fees from Bayer, Böhringer Ingelheim, Pfizer BMS, Daiichi Sankyo, Medtronic, Biotronik, Boston Scientific, and Johnson & Johnson; and grants from Bayer, Pfizer BMS, and Boston Scientific. Laurent Roten receives speaker honoraria from Abbott/SJM and consulting honoraria from Medtronic. Richard Kobza received institutional grants from Abbott, Biosense-Webster, Biotronik, Boston-Scientific, Medtronic, and SIS-Medica. Tobias Reichlin has received research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, the European Union [Eurostars 9799 – ALVALE), and the Cardiovascular Research Foundation Basel, all for work outside the submitted study. He has received speaker/ consulting honoraria or travel support from Abbott/ SJM, Astra Zeneca, Brahms, Bayer, Biosense-Webster, Biotronik, Boston-Scientific, Daiichi Sankyo, Medtronic, Pfizer-BMS, and Roche, all for work outside the submitted study. He has received support for his institution’s fellowship program from Abbott/SJM, Biosense-Webster, Biotronik, Boston-Scientific, and Medtronic, for work outside the submitted study. The remaining authors have no disclosures to report.

Funding Information:
The Swiss-AF study (clinical trial number NCT02105844) is supported by grants of the Swiss National Science Foundation (grant numbers 33CS30_148474, 33CS30_177520, and 32473B_176178), the Swiss Heart Foundation, the Foundation for Cardiovascular Research Basel, and the University of Basel.

Publisher Copyright:
© 2021 The Authors.

Copyright:
Copyright 2022 Elsevier B.V., All rights reserved.

Keywords

atrial fibrillation
cardiovascular disease
cognitive impairment
diabetes
quality of life

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@article{5ddb8920884a43bd86df154089759027,

title = "Association of Diabetes With Atrial Fibrillation Phenotype and Cardiac and Neurological Comorbidities: Insights From the Swiss-AF Study",

abstract = "Background Diabetes is a major risk factor for atrial fibrillation (AF). However, it remains unclear whether individual AF phenotype and related comorbidities differ between patients who have AF with and without diabetes. This study investigated the association of diabetes with AF phenotype and cardiac and neurological comorbidities in patients with documented AF. Methods and Results Participants in the multicenter Swiss-AF (Swiss Atrial Fibrillation) study with data on diabetes and AF phenotype were eligible. Primary outcomes were parameters of AF phenotype, including AF type, AF symptoms, and quality of life (assessed by the European Quality of Life-5 Dimensions Questionnaire [EQ-5D]). Secondary outcomes were cardiac (ie, history of hypertension, myocardial infarction, and heart failure) and neurological (ie, history of stroke and cognitive impairment) comorbidities. The cross-sectional association of diabetes with these outcomes was assessed using logistic and linear regression, adjusted for age, sex, and cardiovascular risk factors. We included 2411 patients with AF (27.4% women; median age, 73.6 years). Diabetes was not associated with nonparoxysmal AF (odds ratio [OR], 1.01; 95% CI, 0.81-1.27). Patients with diabetes less often perceived AF symptoms (OR, 0.74; 95% CI, 0.59-0.92) but had worse quality of life (β=-4.54; 95% CI, -6.40 to -2.68) than those without diabetes. Patients with diabetes were more likely to have cardiac (hypertension [OR, 3.04; 95% CI, 2.19-4.22], myocardial infarction [OR, 1.55; 95% CI, 1.18-2.03], heart failure [OR, 1.99; 95% CI, 1.57-2.51]) and neurological (stroke [OR, 1.39, 95% CI, 1.03-1.87], cognitive impairment [OR, 1.75, 95% CI, 1.39-2.21]) comorbidities. Conclusions Patients who have AF with diabetes less often perceive AF symptoms but have worse quality of life and more cardiac and neurological comorbidities than those without diabetes. This raises the question of whether patients with diabetes should be systematically screened for silent AF. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02105844.",

keywords = "atrial fibrillation, cardiovascular disease, cognitive impairment, diabetes, quality of life",

author = "{of the Swiss‐Investigators} and Arjola Bano and Nicolas Rodondi and Beer, {J{\"u}rg H} and Giorgio Moschovitis and Richard Kobza and Stefanie Aeschbacher and Oliver Baretella and Taulant Muka and Christoph Stettler and Franco, {Oscar H} and Giulio Conte and Christian Sticherling and Zuern, {Christine S} and David Conen and Michael K{\"u}hne and Stefan Osswald and Laurent Roten and Tobias Reichlin",

note = "Funding Information: David Conen holds a McMaster University Department of Medicine Mid-Career Research Award, and has received speaker fees from Servier Canada, outside of the submitted work. Nicolas Rodondi received a grant from the Swiss Heart Foundation. J{\"u}rg H. Beer reports grants from the Swiss National Foundation of Science and The Swiss Heart Foundation; grants from Bayer; and lecture fees from Sanofi Aventis and Amgen, to the institution outside the submitted work. Giorgio Moschovitis has received consultant fees for taking part in advisory boards from Novartis, Astra Zeneca, Bayer, and B{\"o}hringer Ingelheim, outside of the submitted work. Giulio Conte reports a research grant from the Swiss National Science Foundation, and research grants from Boston Scientific Inc. Christian Sticherling has received speaker honoraria from Biosense Webster, Boston Scientific, and Medtronic; and research grants from Biosense Webster, Daiichi-Sankyo, and Medtronic. He is a proctor for Medtronic (Cryoballoon). Christine S. Zuern reports a research grant from Medtronic and speaker fees from Vifor Pharma and Novartis. Michael K{\"u}hne reports personal fees from Bayer, B{\"o}hringer Ingelheim, Pfizer BMS, Daiichi Sankyo, Medtronic, Biotronik, Boston Scientific, and Johnson & Johnson; and grants from Bayer, Pfizer BMS, and Boston Scientific. Laurent Roten receives speaker honoraria from Abbott/SJM and consulting honoraria from Medtronic. Richard Kobza received institutional grants from Abbott, Biosense-Webster, Biotronik, Boston-Scientific, Medtronic, and SIS-Medica. Tobias Reichlin has received research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, the European Union [Eurostars 9799 – ALVALE), and the Cardiovascular Research Foundation Basel, all for work outside the submitted study. He has received speaker/ consulting honoraria or travel support from Abbott/ SJM, Astra Zeneca, Brahms, Bayer, Biosense-Webster, Biotronik, Boston-Scientific, Daiichi Sankyo, Medtronic, Pfizer-BMS, and Roche, all for work outside the submitted study. He has received support for his institution{\textquoteright}s fellowship program from Abbott/SJM, Biosense-Webster, Biotronik, Boston-Scientific, and Medtronic, for work outside the submitted study. The remaining authors have no disclosures to report. Funding Information: The Swiss-AF study (clinical trial number NCT02105844) is supported by grants of the Swiss National Science Foundation (grant numbers 33CS30_148474, 33CS30_177520, and 32473B_176178), the Swiss Heart Foundation, the Foundation for Cardiovascular Research Basel, and the University of Basel. Publisher Copyright: {\textcopyright} 2021 The Authors. Copyright: Copyright 2022 Elsevier B.V., All rights reserved.",

year = "2021",

month = nov,

day = "16",

doi = "10.1161/JAHA.121.021800",

language = "English",

volume = "10",

journal = "Journal of the American Heart Association",

issn = "2047-9980",

publisher = "Wiley",

number = "22",

}

TY - JOUR

T1 - Association of Diabetes With Atrial Fibrillation Phenotype and Cardiac and Neurological Comorbidities

T2 - Insights From the Swiss-AF Study

AU - of the Swiss‐Investigators

AU - Bano, Arjola

AU - Rodondi, Nicolas

AU - Beer, Jürg H

AU - Moschovitis, Giorgio

AU - Kobza, Richard

AU - Aeschbacher, Stefanie

AU - Baretella, Oliver

AU - Muka, Taulant

AU - Stettler, Christoph

AU - Franco, Oscar H

AU - Conte, Giulio

AU - Sticherling, Christian

AU - Zuern, Christine S

AU - Conen, David

AU - Kühne, Michael

AU - Osswald, Stefan

AU - Roten, Laurent

AU - Reichlin, Tobias

N1 - Funding Information: David Conen holds a McMaster University Department of Medicine Mid-Career Research Award, and has received speaker fees from Servier Canada, outside of the submitted work. Nicolas Rodondi received a grant from the Swiss Heart Foundation. Jürg H. Beer reports grants from the Swiss National Foundation of Science and The Swiss Heart Foundation; grants from Bayer; and lecture fees from Sanofi Aventis and Amgen, to the institution outside the submitted work. Giorgio Moschovitis has received consultant fees for taking part in advisory boards from Novartis, Astra Zeneca, Bayer, and Böhringer Ingelheim, outside of the submitted work. Giulio Conte reports a research grant from the Swiss National Science Foundation, and research grants from Boston Scientific Inc. Christian Sticherling has received speaker honoraria from Biosense Webster, Boston Scientific, and Medtronic; and research grants from Biosense Webster, Daiichi-Sankyo, and Medtronic. He is a proctor for Medtronic (Cryoballoon). Christine S. Zuern reports a research grant from Medtronic and speaker fees from Vifor Pharma and Novartis. Michael Kühne reports personal fees from Bayer, Böhringer Ingelheim, Pfizer BMS, Daiichi Sankyo, Medtronic, Biotronik, Boston Scientific, and Johnson & Johnson; and grants from Bayer, Pfizer BMS, and Boston Scientific. Laurent Roten receives speaker honoraria from Abbott/SJM and consulting honoraria from Medtronic. Richard Kobza received institutional grants from Abbott, Biosense-Webster, Biotronik, Boston-Scientific, Medtronic, and SIS-Medica. Tobias Reichlin has received research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, the European Union [Eurostars 9799 – ALVALE), and the Cardiovascular Research Foundation Basel, all for work outside the submitted study. He has received speaker/ consulting honoraria or travel support from Abbott/ SJM, Astra Zeneca, Brahms, Bayer, Biosense-Webster, Biotronik, Boston-Scientific, Daiichi Sankyo, Medtronic, Pfizer-BMS, and Roche, all for work outside the submitted study. He has received support for his institution’s fellowship program from Abbott/SJM, Biosense-Webster, Biotronik, Boston-Scientific, and Medtronic, for work outside the submitted study. The remaining authors have no disclosures to report. Funding Information: The Swiss-AF study (clinical trial number NCT02105844) is supported by grants of the Swiss National Science Foundation (grant numbers 33CS30_148474, 33CS30_177520, and 32473B_176178), the Swiss Heart Foundation, the Foundation for Cardiovascular Research Basel, and the University of Basel. Publisher Copyright: © 2021 The Authors. Copyright: Copyright 2022 Elsevier B.V., All rights reserved.

PY - 2021/11/16

Y1 - 2021/11/16

N2 - Background Diabetes is a major risk factor for atrial fibrillation (AF). However, it remains unclear whether individual AF phenotype and related comorbidities differ between patients who have AF with and without diabetes. This study investigated the association of diabetes with AF phenotype and cardiac and neurological comorbidities in patients with documented AF. Methods and Results Participants in the multicenter Swiss-AF (Swiss Atrial Fibrillation) study with data on diabetes and AF phenotype were eligible. Primary outcomes were parameters of AF phenotype, including AF type, AF symptoms, and quality of life (assessed by the European Quality of Life-5 Dimensions Questionnaire [EQ-5D]). Secondary outcomes were cardiac (ie, history of hypertension, myocardial infarction, and heart failure) and neurological (ie, history of stroke and cognitive impairment) comorbidities. The cross-sectional association of diabetes with these outcomes was assessed using logistic and linear regression, adjusted for age, sex, and cardiovascular risk factors. We included 2411 patients with AF (27.4% women; median age, 73.6 years). Diabetes was not associated with nonparoxysmal AF (odds ratio [OR], 1.01; 95% CI, 0.81-1.27). Patients with diabetes less often perceived AF symptoms (OR, 0.74; 95% CI, 0.59-0.92) but had worse quality of life (β=-4.54; 95% CI, -6.40 to -2.68) than those without diabetes. Patients with diabetes were more likely to have cardiac (hypertension [OR, 3.04; 95% CI, 2.19-4.22], myocardial infarction [OR, 1.55; 95% CI, 1.18-2.03], heart failure [OR, 1.99; 95% CI, 1.57-2.51]) and neurological (stroke [OR, 1.39, 95% CI, 1.03-1.87], cognitive impairment [OR, 1.75, 95% CI, 1.39-2.21]) comorbidities. Conclusions Patients who have AF with diabetes less often perceive AF symptoms but have worse quality of life and more cardiac and neurological comorbidities than those without diabetes. This raises the question of whether patients with diabetes should be systematically screened for silent AF. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02105844.

AB - Background Diabetes is a major risk factor for atrial fibrillation (AF). However, it remains unclear whether individual AF phenotype and related comorbidities differ between patients who have AF with and without diabetes. This study investigated the association of diabetes with AF phenotype and cardiac and neurological comorbidities in patients with documented AF. Methods and Results Participants in the multicenter Swiss-AF (Swiss Atrial Fibrillation) study with data on diabetes and AF phenotype were eligible. Primary outcomes were parameters of AF phenotype, including AF type, AF symptoms, and quality of life (assessed by the European Quality of Life-5 Dimensions Questionnaire [EQ-5D]). Secondary outcomes were cardiac (ie, history of hypertension, myocardial infarction, and heart failure) and neurological (ie, history of stroke and cognitive impairment) comorbidities. The cross-sectional association of diabetes with these outcomes was assessed using logistic and linear regression, adjusted for age, sex, and cardiovascular risk factors. We included 2411 patients with AF (27.4% women; median age, 73.6 years). Diabetes was not associated with nonparoxysmal AF (odds ratio [OR], 1.01; 95% CI, 0.81-1.27). Patients with diabetes less often perceived AF symptoms (OR, 0.74; 95% CI, 0.59-0.92) but had worse quality of life (β=-4.54; 95% CI, -6.40 to -2.68) than those without diabetes. Patients with diabetes were more likely to have cardiac (hypertension [OR, 3.04; 95% CI, 2.19-4.22], myocardial infarction [OR, 1.55; 95% CI, 1.18-2.03], heart failure [OR, 1.99; 95% CI, 1.57-2.51]) and neurological (stroke [OR, 1.39, 95% CI, 1.03-1.87], cognitive impairment [OR, 1.75, 95% CI, 1.39-2.21]) comorbidities. Conclusions Patients who have AF with diabetes less often perceive AF symptoms but have worse quality of life and more cardiac and neurological comorbidities than those without diabetes. This raises the question of whether patients with diabetes should be systematically screened for silent AF. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02105844.

KW - atrial fibrillation

KW - cardiovascular disease

KW - cognitive impairment

KW - diabetes

KW - quality of life

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U2 - 10.1161/JAHA.121.021800

DO - 10.1161/JAHA.121.021800

M3 - Article

C2 - 34753292

VL - 10

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 22

M1 - e021800

ER -

Association of Diabetes With Atrial Fibrillation Phenotype and Cardiac and Neurological Comorbidities: Insights From the Swiss-AF Study

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Bibliographical note

Keywords

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