Atrial fibrillation: increased risk with heart failure, hypertension and valvular heart disease.

Clinical bottom line (level 1b)

  1. A tenth of older people developed atrial fibrillation.
  2. Patients with the following prognostic factors were at increased risk of developing atrial fibrillation:
    • congestive heart failure
    • hypertension
    • valvular heart disease
    • diabetes mellitus
Benjamin et al: Journal of the AMerican Medical Journal 1994; 271 (11): 840-844
Expires November 2003

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: community, USA

4731 patients (aged range 55 to 94 years, 56% female) underwent biannual physical examination

Excluded if
  • already in atrial fibrillation



    • Factors studied:
  • atrial fibrillation
  • men: congestive heart failure
  • men: hypertension >160/95 mmHg
  • men: valvular heart disease
  • men: myocardial infarction
  • men: diabetes
  • men: age/ 10 years
  • women: valvular heart disease
  • women: congestive heart failure
  • women: hypertension
  • women: cigarette smoking
  • women: diabetes
  • women: age /10 years




    • Multivariate regression analysis was used to adjust for confounding factors.

    100% followed for 38 years
    Outcomes studied:
  • atrial fibrillation

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    atrial fibrillation 38 years 562/4731 12%
    (11% to 13%)

    prognostic factor for
    atrial fibrillation     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    men: congestive heart failure ? /
    (3.2%)     		4.5
    (3.1 to 6.6)     		10
    (7 to 16)
    men: hypertension ? /
    (30.9%)     		1.5
    (1.2 to 2.0)     		11
    (6 to 25)
    men: valvular heart disease ? /
    (6.7%)     		1.8
    (1.2 to 2.5)     		21
    (12 to 81)
    men: myocardial infarction ? /
    (13.0%)     		1.4
    (1.0 to 2.0)     		23
    (10 to infinity)
    men: diabetes ? /
    (10.2%)     		1.4
    (1.0 to 2.0)     		28
    (12 to infinity)
    men: age/ 10 years ? /
    (%)     		2.1
    (1.8 to 2.5)
    ( to )
    women: valvular heart disease ? /
    (8.7%)     		3.4
    (2.5 to 4.5)     		6
    (5 to 9)
    women: congestive heart failure ? /
    (2.9%)     		5.9
    (4.2 to 8.4)     		8
    (6 to 12)
    women: hypertension ? /
    (40.7%)     		1.4
    (1.1 to 1.8)     		12
    (7 to 43)
    women: cigarette smoking ? /
    (23.4%)     		1.4
    (1.0 to 2.0)     		15
    (7 to infinity)
    women: diabetes ? /
    (7.5%)     		1.6
    (1.1 to 2.2)     		25
    (13 to 150)
    women: age /10 years ? /
    (%)     		2.2
    (1.9 to 2.6)
    ( to )

    • FEV1, alcohol and obesity were not found to have any link to development of AF.

    Comments

    1. The study was not blinded.

    Citation

    1. Benjamin EJ, Levy D, Vaziri SM, et al: Independent risk factors for atrial fibrillation in a population-based cohort: The Framingham Heart Study. Journal of the AMerican Medical Journal 1994; 271 (11): 840-844
    Contributor: Nick Shenker and Chris Ball, November 2000
    Reviewer:

    Clinical Question.
    Patient biannual physical examination
    Intervention or Exposure risk factors
    Outcome atrial fibrillation