High overall cardiovascular risk and mortality in patients with atrial fibrillation and diabetes: A nationwide report

Aim: To describe nationwide complication patterns in patients with atrial fibrillation and diabetes mellitus. Methods: All (n = 326,832) patients in Sweden with non-valvular atrial fibrillation during 2006-2012 were identified, and information on events, comorbidities and pharmacological therapy was extracted using nationwide mandatory registers. Patients were followed until 31 December 2013 and the mean follow-up time was 3.7 years (0.9-8 years). Results: Diabetes was present in 17.7%. The most frequent events in those with and without diabetes were mortality (48.8% vs 36.4%; p < 0.001), heart failure (21.4% vs 13.1%; p < 0.001), ischaemic stroke (8.2% vs 6.8%; p < 0.001), myocardial infarction (7.3% vs 4.3%; p < 0.001) and any bleeding (6.3% vs 5.2%; p < 0.001), respectively. Diabetes predicted mortality (hazard ratio = 1.28; 95% confidence interval = 1.25-1.31), combined event (first of mortality, heart failure, ischaemic stroke or myocardial infarction; hazard ratio = 1.22; 95% confidence interval = 1.20-1.25), single events and bleeding (hazard ratio = 1.12; 95% confidence interval = 1.06-1.19). The standardised mortality ratio for patients with atrial fibrillation and diabetes compared to the general population was 2.06 (95% confidence interval = 2.00-2.12) and for patients with atrial fibrillation without diabetes was 1.33 (95% confidence interval = 1.31-1.35). Conclusion: In this real-world setting, patients with atrial fibrillation and diabetes have a high cardiovascular risk, with mortality and heart failure rates exceeding those for stroke.