Improved prognosis with integrated care management including early rhythm control and healthy lifestyle modification in patients with concurrent atrial fibrillation and diabetes mellitus: a nationwide cohort study
Abstract Background Patients with concurrent atrial fibrillation (AF) and diabetes mellitus (DM) [AF-DM] have a high risk of cardiovascular and diabetes-related complications, but are less engaged in a comprehensive treatment approach. We evaluated the association of early rhythm control (ERC), life...
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12933-023-01749-z |
| _version_ | 1811171921009573888 |
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| author | So-Ryoung Lee Hyo-Jeong Ahn Eue-Keun Choi Seung-Woo Lee Kyung-Do Han Seil Oh Gregory Y. H. Lip |
| author_facet | So-Ryoung Lee Hyo-Jeong Ahn Eue-Keun Choi Seung-Woo Lee Kyung-Do Han Seil Oh Gregory Y. H. Lip |
| author_sort | So-Ryoung Lee |
| collection | DOAJ |
| description | Abstract Background Patients with concurrent atrial fibrillation (AF) and diabetes mellitus (DM) [AF-DM] have a high risk of cardiovascular and diabetes-related complications, but are less engaged in a comprehensive treatment approach. We evaluated the association of early rhythm control (ERC), lifestyle modification (LSM), and a combination of ERC and LSM with cardiovascular or diabetes-related complication risk in patients with AF-DM (type 2). Methods From the National Health Information Database, 47,940 patients diagnosed with AF-DM in 2009–2016 were included. We defined ERC as rhythm control therapy within two years of AF diagnosis and LSM as adherence to ≥ 2 of the healthy behaviors among non-current smoking, non-drinking, and regular exercise. We compared the primary (ischemic stroke) and secondary (macro- and microvascular complications, glycemic emergency, and all-cause death) outcomes in four groups: non-ERC and non-LSM (group 1), LSM only (group 2), ERC only (group 3), and both ERC and LSM (group 4). Results Of total, 10,617 (22%), 26,730 (55.8%), 2,903 (6.1%), and 7,690 (16.0%) were classified into groups 1 to 4, in sequence. The mean duration from AF diagnosis to ERC was 25.6 ± 75.5 days. During 4.0 (interquartile range: 2.5–6.2) years’ follow-up, groups 2 and 3 were associated with 23% and 33% lower risks of stroke than group 1, respectively. Group 4 was associated with the lowest risk of stroke: hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.51–0.67, p < 0.001. Regarding secondary outcomes, the lowest risks were also observed in group 4; macro- and microvascular complications, glycemic emergency, and all-cause death had HRs (95% CIs) of 0.63 (0.56–0.70), 0.88 (0.82–0.94), 0.72 (0.62–0.84), and 0.80 (0.73–0.87), respectively, all p < 0.001. Conclusions For AF-DM patients, ERC and LSM exert a synergistic effect in preventing cardiovascular and diabetes-related complications with the greatest lowered risk of stroke. A comprehensive treatment approach should be pursued in AF-DM patients. |
| first_indexed | 2024-04-10T17:22:13Z |
| format | Article |
| id | doaj.art-fc097175cbc2482b8f1cb0d507c055c8 |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-04-10T17:22:13Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-fc097175cbc2482b8f1cb0d507c055c82023-02-05T12:03:58ZengBMCCardiovascular Diabetology1475-28402023-01-0122111310.1186/s12933-023-01749-zImproved prognosis with integrated care management including early rhythm control and healthy lifestyle modification in patients with concurrent atrial fibrillation and diabetes mellitus: a nationwide cohort studySo-Ryoung Lee0Hyo-Jeong Ahn1Eue-Keun Choi2Seung-Woo Lee3Kyung-Do Han4Seil Oh5Gregory Y. H. Lip6Department of Internal Medicine, Seoul National University HospitalDepartment of Internal Medicine, Seoul National University HospitalDepartment of Internal Medicine, Seoul National University HospitalDepartment of Medical Statistics, College of Medicine, Catholic University of KoreaStatistics and Actuarial Science, Soongsil UniversityDepartment of Internal Medicine, Seoul National University HospitalDepartment of Internal Medicine, Seoul National University College of MedicineAbstract Background Patients with concurrent atrial fibrillation (AF) and diabetes mellitus (DM) [AF-DM] have a high risk of cardiovascular and diabetes-related complications, but are less engaged in a comprehensive treatment approach. We evaluated the association of early rhythm control (ERC), lifestyle modification (LSM), and a combination of ERC and LSM with cardiovascular or diabetes-related complication risk in patients with AF-DM (type 2). Methods From the National Health Information Database, 47,940 patients diagnosed with AF-DM in 2009–2016 were included. We defined ERC as rhythm control therapy within two years of AF diagnosis and LSM as adherence to ≥ 2 of the healthy behaviors among non-current smoking, non-drinking, and regular exercise. We compared the primary (ischemic stroke) and secondary (macro- and microvascular complications, glycemic emergency, and all-cause death) outcomes in four groups: non-ERC and non-LSM (group 1), LSM only (group 2), ERC only (group 3), and both ERC and LSM (group 4). Results Of total, 10,617 (22%), 26,730 (55.8%), 2,903 (6.1%), and 7,690 (16.0%) were classified into groups 1 to 4, in sequence. The mean duration from AF diagnosis to ERC was 25.6 ± 75.5 days. During 4.0 (interquartile range: 2.5–6.2) years’ follow-up, groups 2 and 3 were associated with 23% and 33% lower risks of stroke than group 1, respectively. Group 4 was associated with the lowest risk of stroke: hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.51–0.67, p < 0.001. Regarding secondary outcomes, the lowest risks were also observed in group 4; macro- and microvascular complications, glycemic emergency, and all-cause death had HRs (95% CIs) of 0.63 (0.56–0.70), 0.88 (0.82–0.94), 0.72 (0.62–0.84), and 0.80 (0.73–0.87), respectively, all p < 0.001. Conclusions For AF-DM patients, ERC and LSM exert a synergistic effect in preventing cardiovascular and diabetes-related complications with the greatest lowered risk of stroke. A comprehensive treatment approach should be pursued in AF-DM patients.https://doi.org/10.1186/s12933-023-01749-zEarly rhythm controlLifestyle modificationAtrial fibrillationDiabetes mellitus |
| spellingShingle | So-Ryoung Lee Hyo-Jeong Ahn Eue-Keun Choi Seung-Woo Lee Kyung-Do Han Seil Oh Gregory Y. H. Lip Improved prognosis with integrated care management including early rhythm control and healthy lifestyle modification in patients with concurrent atrial fibrillation and diabetes mellitus: a nationwide cohort study Cardiovascular Diabetology Early rhythm control Lifestyle modification Atrial fibrillation Diabetes mellitus |
| title | Improved prognosis with integrated care management including early rhythm control and healthy lifestyle modification in patients with concurrent atrial fibrillation and diabetes mellitus: a nationwide cohort study |
| title_full | Improved prognosis with integrated care management including early rhythm control and healthy lifestyle modification in patients with concurrent atrial fibrillation and diabetes mellitus: a nationwide cohort study |
| title_fullStr | Improved prognosis with integrated care management including early rhythm control and healthy lifestyle modification in patients with concurrent atrial fibrillation and diabetes mellitus: a nationwide cohort study |
| title_full_unstemmed | Improved prognosis with integrated care management including early rhythm control and healthy lifestyle modification in patients with concurrent atrial fibrillation and diabetes mellitus: a nationwide cohort study |
| title_short | Improved prognosis with integrated care management including early rhythm control and healthy lifestyle modification in patients with concurrent atrial fibrillation and diabetes mellitus: a nationwide cohort study |
| title_sort | improved prognosis with integrated care management including early rhythm control and healthy lifestyle modification in patients with concurrent atrial fibrillation and diabetes mellitus a nationwide cohort study |
| topic | Early rhythm control Lifestyle modification Atrial fibrillation Diabetes mellitus |
| url | https://doi.org/10.1186/s12933-023-01749-z |
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