Airy M, et al. - This investigation was pursued to gain a better understanding of the cardiovascular risks of incident atrial fibrillation/flutter (AF) in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). Findings demonstrated a strong association of AF with increased risks of ischemic stroke, myocardial infarction (MI) and death. Notably, risks were highest soon after AF diagnosis but extended beyond 90 days.

Methods

• Researchers studied older US patients who newly initiated HD for ESRD (2006–11) and who had not previously been diagnosed with AF, stroke, myocardial infarction (MI) or hip fracture.
• Using Cox regression with AF as a time-varying covariate, adjusted for socio-demographic characteristics and comorbidities, researchers estimated hazard ratios [HRs (95% confidence intervals)] for the events of ischemic stroke, MI and death.
• Hip fracture served as a negative control outcome.

Results

• A total of 85,377 older patients (mean age: 76.5 years) who initiated HD were identified.
• Among these, AF was subsequently detected in 14.3% (14.9% there of as primary diagnosis) and 49.8% died during follow-up.
• Findings demonstrated a relation of incident AF with nine times higher adjusted mortality during the first 30 days [9.2 (8.8–9.6)], 5-fold higher mortality between 31 and 90 days [4.6 (4.3–4.8)] and double the mortality beyond 90 days from first AF diagnosis [2.2 (2.1–2.3)].
• Researchers observed that, similarly, incident AF was related to higher adjusted risk of ischemic stroke: 2.1 (1.6–2.7) during the first 30 days, 2.5 (2.0–3.0) between 31 and 90 days and 1.5 (1.3–1.7) beyond 90 days.
• Data reported similar findings for MI.
• However, after AF diagnosis, the risk of hip fracture was only marginally increased [≤30 days: 1.1 (0.7–1.6); 31–90 days: 1.4 (1.0–1.8); >90 days: 1.2 (1.1–1.4)].
• In addition, it was noted that when incident AF was defined by a primary diagnosis code, all links were reduced and the association with hip fracture was null.