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.
Bibliographical noteFunding 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.
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.
© 2021 The Authors.
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- atrial fibrillation
- cardiovascular disease
- cognitive impairment
- quality of life