Adverse Events and Clinical Correlates in Asian Patients with Atrial Fibrillation and Diabetes Mellitus: A Report from Asia Pacific Heart Rhythm Society Atrial Fibrillation Registry

Bucci, T ORCID: 0000-0003-2895-6234, Nabrdalik, K ORCID: 0000-0002-0777-8048, Shantsila, A ORCID: 0000-0002-0594-8576, Romiti, GF ORCID: 0000-0002-3788-8942, Teo, WS, Park, HW, Shimizu, W ORCID: 0000-0001-9941-8973, Tse, HF, Proietti, M ORCID: 0000-0003-1452-2478, Chao, TF, Lip, GYH ORCID: 0000-0002-7566-1626 and A-PHRSAFR (2024) Adverse Events and Clinical Correlates in Asian Patients with Atrial Fibrillation and Diabetes Mellitus: A Report from Asia Pacific Heart Rhythm Society Atrial Fibrillation Registry. Journal of Clinical Medicine, 13 (5). p. 1274. ISSN 2077-0383

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Abstract

Aims. To evaluate the adverse events (and its clinical correlates) in a large prospective cohort of Asian patients with atrial fibrillation (AF) and diabetes mellitus (DM). Material and Methods. We recruited patients with atrial fibrillation (AF) from the Asia-Pacific Heart Rhythm Society (APHRS) AF Registry and included those for whom the diabetic mellitus (DM) status was known. We used Cox-regression analysis to assess the 1-year risk of all-cause death, thromboembolic events, acute coronary syndrome, heart failure and major bleeding. Results. Of 4058 patients (mean age 68.5 ± 11.8 years; 34.4% females) considered for this analysis, 999 (24.6%) had DM (age 71 ± 11 years, 36.4% females). Patients with DM had higher mean CHA2DS2-VASc (2.3 ± 1.6 vs. 4.0 ± 1.5, p < 0.001) and HAS-BLED (1.3 ± 1.0 vs. 1.7 ± 1.1, p < 0.001) risk scores and were less treated with rhythm control strategies compared to patients without DM (18.7% vs. 22.0%). After 1-year of follow-up, patients with DM had higher incidence of all-cause death (4.9% vs. 2.3%, p < 0.001), cardiovascular death (1.3% vs. 0.4%, p = 0.003), and major bleeding (1.8% vs. 0.9%, p = 0.002) compared to those without DM. On Cox regression analysis, adjusted for age, sex, heart failure, coronary and peripheral artery diseases and previous thromboembolic event, DM was independently associated with a higher risk of all-cause death (HR 1.48, 95% CI 1.00–2.19), cardiovascular death (HR 2.33, 95% CI 1.01–5.40), and major bleeding (HR 1.91, 95% 1.01–3.60). On interaction analysis, the impact of DM in determining the risk of all-cause death was greater in young than in older patients (p int = 0.010). Conclusions. Given the high rates of adverse outcomes in these Asian AF patients with DM, efforts to optimize the management approach of these high-risk patients in a holistic or integrated care approach are needed.

Item Type:	Article
Uncontrolled Keywords:	Asians; atrial fibrillation; cardiovascular events; diabetes; major bleedings; 1103 Clinical Sciences
Subjects:	R Medicine > R Medicine (General)
Divisions:	Nursing and Advanced Practice
Publisher:	MDPI
Date of acceptance:	19 February 2024
Date of first compliant Open Access:	8 May 2024
Date Deposited:	08 May 2024 13:26
Last Modified:	04 Jul 2025 12:15
DOI or ID number:	10.3390/jcm13051274
URI:	https://researchonline.ljmu.ac.uk/id/eprint/23200

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