Incident Atrial Fibrillation and Disability-Free Survival in the Cardiovascular Health Study

Erin R. Wallace, David S. Siscovick, Colleen M. Sitlani, Sascha Dublin, Pamela H. Mitchell, Michelle C. Odden, Calvin H Hirsch, Stephen Thielke, Susan R. Heckbert

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Objectives To assess the associations between incident atrial fibrillation (AF) and disability-free survival and risk of disability. Design Prospective cohort study. Setting Cardiovascular Health Study. Participants Individuals aged 65 and older and enrolled in fee-for-service Medicare followed between 1991 and 2009 (MN = 4,046). Individuals with prevalent AF, activity of daily living (ADL) disability, or a history of stroke or heart failure at baseline were excluded. Measurements Incident AF was identified according to annual study electrocardiogram, hospital discharge diagnosis, or Medicare claims. Disability-free survival was defined as survival free of ADL disability (any difficulty or inability in bathing, dressing, eating, using the toilet, walking around the home, or getting out of a bed or chair). ADLs were assessed at annual study visits or in a telephone interview. Association between incident AF and disability-free survival or risk of disability was estimated using Cox proportional hazards models. Results Over an average of 7.0 years of follow-up, 660 individuals (16.3%) developed incident AF, and 3,112 (77%) became disabled or died. Incident AF was associated with shorter disability-free survival (hazard ratio (HR) for death or ADL disability = 1.71, 95% confidence interval (CI) = 1.55-1.90) and a higher risk of ADL disability (HR = 1.36, 95% CI = 1.18-1.58) than in individuals with no history of AF. This association persisted after adjustment for interim stroke and heart failure. Conclusion These results suggest that AF is a risk factor for shorter functional longevity in older adults, independent of other risk factors and comorbid conditions.

Original languageEnglish (US)
Pages (from-to)838-843
Number of pages6
JournalJournal of the American Geriatrics Society
Volume64
Issue number4
DOIs
StatePublished - Apr 1 2016

Keywords

  • atrial fibrillation
  • disability
  • disability-free survival

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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    Wallace, E. R., Siscovick, D. S., Sitlani, C. M., Dublin, S., Mitchell, P. H., Odden, M. C., Hirsch, C. H., Thielke, S., & Heckbert, S. R. (2016). Incident Atrial Fibrillation and Disability-Free Survival in the Cardiovascular Health Study. Journal of the American Geriatrics Society, 64(4), 838-843. https://doi.org/10.1111/jgs.14037