Atrial fibrillation (AFib) – an abnormal heart rhythm that affects the heart’s upper chambers and can increase the risk of stroke and heart failure – is not restricted to older people, say scientists, who suggest it is increasingly affecting people under 65.
In their recent study, published in Circulation: Arrhythmia and Electrophysiology, they highlighted the need to manage risk factors and AFib among younger individuals.
They said while the condition is more likely to occur in adults aged between 70 and 80, it appears to be affecting an increasing number of younger people
The researchers included 67 221 adults with AFib as part of their study. Of this number, 17 were under 65.
Researchers looked at all-cause mortality, hospitalisations, and other cardiac interventions that participants received: the average follow-up time was about five years.
During the follow-up, 2 084 participants died.
The researchers found that those under age 65 had notable additional cardiovascular risk factors. For example, 16% were current smokers, 55% had high blood pressure, 20% had heart failure, 21% had diabetes, and more than 20% had significant obesity. Additionally, more than half of the participants under 65 were receiving anticoagulants.
Overall, researchers found that those under 65 with AFib had an increased mortality risk compared with an internal control population, and an increased risk for hospitalisation from heart attack, heart failure, and all-cause stroke.
Study author Aditya Bhonsale, MD, MHS, assistant professor of medicine with the Division of Cardiac Electrophysiology at the University of Pittsburgh Medical Centre Heart and Vascular Institute, told MedicalNewsToday: “Our large real-world cohort demonstrates that AFib patients under 65 have substantial comorbidity burden, particularly, obesity, heart failure, and hypertension with considerable long-term mortality (6.7% <50 years; 13% 50-65 years).
“They are also at a significantly increased risk of hospitalisation for heart failure, stroke, and myocardial infarction compared with those without AFib.
“Our study suggests that management of AFib patients under 65 must be in the context of their individual CV risk factors burden, and lifestyle modification with appropriate focus on non-cardiac risk factors.”
Limitations
This research does have limitations. First, it cannot establish cause, and second, 95% of the participants were white, so researchers can include more diverse cohorts in the future.
In the population under 50, 73% of participants were male, so more research in the future could potentially focus on females with AFib.
The researchers acknowledge that they did not measure quality of life metrics or ascertain the cause of death among participants. They also lacked information on alcohol consumption, which could have affected existing relationships.
“Research on impact of risk factor modification and trajectories of risk factors in younger patients needs [to be] done in the future,” noted Bhonsale. “This will allow for optimal management and mitigate adverse outcomes.”
Study details
Mortality, hospitalisation, and cardiac interventions in patients with atrial fibrillation aged <65 years
Aditya Bhonsale, Jianhui Zhu, Sandeep Jain et al.
Published in Circulation: Arrhythmia and Electrophysiology on 22 April 2024
Abstract
Background
The risk factor (RF) burden, clinical course, and long-term outcome among patients with atrial fibrillation (AF) aged <65 years is unclear.
Methods
Adult (n=67 221; mean age, 72.4±12.3 years; and 45% female) patients with AF evaluated at the University of Pittsburgh Medical Centre between January 2010 and December 2019 were studied. Hospital system–wide electronic health records and administrative data were utilised to ascertain RFs, comorbidities, and subsequent hospitalisation and cardiac interventions. The association of AF with all-cause mortality among those aged <65 years was analysed using an internal contemporary cohort of patients without AF (n=918 073).
Results
Nearly one-quarter (n=17 335) of the cohort was aged <65 years (32% female) with considerable cardiovascular RFs (current smoker, 16%; mean body mass index, 33.0±8.3; hypertension, 55%; diabetes, 21%; heart failure, 20%; coronary artery disease, 19%; and prior ischaemic stroke, 6%) and comorbidity burden (chronic obstructive pulmonary disease, 11%; obstructive sleep apnea, 18%; and chronic kidney disease, 1.3%). Over mean follow-up of >5 years, 2084 (6.7%, <50 years; 13%, 50–65 years) patients died. The proportion of patients with >1 hospitalisation for myocardial infarction, heart failure, and stroke was 1.3%, 4.8%, and 1.1% for those aged <50 years and 2.2%, 7.4%, and 1.1% for the 50- to 65-year subgroup, respectively. Multiple cardiac and non-cardiac RFs were associated with increased mortality in younger patients with AF with heart failure and hypertension demonstrating significant age-related interaction (P=0.007 and P=0.013, respectively). Patients with AF aged <65 years experienced significantly worse survival compared with comorbidity-adjusted patients without AF (males aged <50 years and hazard ratio, 1.5 [95% CI, 1.24–1.79]; 50–65 years and hazard ratio, 1.3 [95% CI, 1.26–1.43]; females aged <50 years and hazard ratio, 2.4 [95% CI, 1.82–3.16]; 50–65 years and hazard ratio, 1.7 [95% CI, 1.6–1.92]).
Conclusions
Patients with AF aged <65 years have significant comorbidity burden and considerable long-term mortality. They are also at a significantly increased risk of hospitalisation for heart failure, stroke, and myocardial infarction. These patients warrant an aggressive focus on RF and comorbidity evaluation and management.
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Call to re-assess growing burden of AF and its consequences
Working long hours increases atrial fibrillation risk
Stress, insomnia, tied to post-menopause atrial fibrillation – US study