Individuals with diabetes and atrial fibrillation (AF) vs those without diabetes less often perceive AF symptoms, have more neurological and cardiac comorbidities, and experience a worse quality of life (QOL), according to a study published in the Journal of the American Heart Association.

For the current study, researchers sourced data from the Swiss AF Study (ClinicalTrials.gov Identifier: NCT02105844). A total of 2411 individuals (median age 73.6 years; 27.4% women) with available AF phenotype and diabetes data were included. Primary outcomes included AF symptoms, AF type, and QOL (assessed using the European Quality of Life-5 Dimensions Questionnaire [EQ-5D]). Secondary outcomes included both neurological (cognitive impairment, history of stroke) and cardiac (history of myocardial infarction, heart failure, and hypertension) comorbidities. Associations between diabetes and these outcomes were examined using logistic and linear regression with adjustments for sex, age, and cardiovascular risk. Two analyses were performed: the first adjusted for age as a continuous variable and sex, and the second for potential confounders.

Among the study participants, 17.4% had diabetes. Compared with those without diabetes, those with diabetes were older, more likely to be smokers and men, had higher body mass index (BMI), and had higher stroke risk (P <.001). No significant association was found between diabetes and nonparoxysmal AF (odds ratio [OR], 1.01; 95% CI, 0.81-1.27). Individuals with diabetes perceived AF symptoms less often than those without (OR, 0.74; 95% CI, 0.59-0.92), but had worse QOL (β=-4.54; 95% CI, -6.40 to -2.68). Diabetes was also associated with a higher risk for neurological (cognitive impairment [OR, 1.75; 95% CI, 1.39-2.21] and stroke [OR, 1.39; 95% CI, 1.03-1.87]) and cardiac (heart failure [OR, 1.99; 95% CI, 1.57-2.51], myocardial infarction [OR, 1.55; 95% CI, 1.18-2.03], and hypertension [OR, 3.04; 95% CI, 2.19-4.22]) comorbidities.


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Limitations to this study include potential underreporting of diabetes, a lack of data on diabetes duration, an inability to draw causal conclusions, the potential for residual confounding, and a need for further investigation into the generalizability of these results.

“…[W]e may need to increase vigilance for AF detection in patients with diabetes, further raising the question of whether patients with diabetes should be systematically screened for silent AF,” the study authors said. “In addition, our study shows that patients with diabetes have an increased likelihood of comorbidities and decreased [QOL], which indicates that patients who have AF with diabetes may deserve more attentive care compared with those without diabetes.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Bano A, Rodondi N, Beer JH, et al. Association of diabetes with atrial fibrillation phenotype and cardiac and neurological comorbidities: insights from the Swiss-AF study. J Am Heart Assoc. Published online November 10, 2021. doi:10.1161