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
Main finding · StrokeResult — go to the resultHazard ratio 0.58 95% CI 0.51–0.67Authors' conclusion
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.
Study context
- Population
- Patients with concurrent atrial fibrillation (AF) and diabetes mellitus (DM) (type 2) diagnosed 2009–2016; Early rhythm control (ERC) = rhythm control therapy within 2 years of AF diagnosis; Lifestyle modification (LSM) = adherence to ≥2 of non-current smoking, non-drinking, regular exercise
- Participants
- 47,940 patients
- Exposure
- ERC and/or LSM vs neither ERC nor LSM
- Group 1n = 10,617reference
- Group 2n = 26,730
- Group 3n = 2,903
- Group 4n = 7,690
- Outcome
- Ischemic stroke
- Follow-up
- 4.0 (IQR 2.5-6.2) years
Methodological detailsNational Health Information Database, Mean duration from AF diagnosis to ERC 25.6 ± 75.5 days
- National Health Information Database
- Mean duration from AF diagnosis to ERC 25.6 ± 75.5 days
Main finding
Stroke · 4.0 (IQR 2.5-6.2) years' follow-up
Hazard ratio
0.58
95% CI 0.51–0.67
P < 0.001
Group 4vs Group 1
HR 0.58 (95% CI 0.51–0.67); P < 0.001
As reported in the abstract
- Group 2 vs group 1: lower risk of stroke
- 23%
- Group 3 vs group 1: lower risk of stroke
- 33%
Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Macrovascular complications, group 4Group 4vs Group 1 | 0.63 (0.56–0.70) | P < 0.001 | |
| Microvascular complications, group 4Group 4vs Group 1 | 0.88 (0.82–0.94) | P < 0.001 | |
| Glycemic emergency, group 4Group 4vs Group 1 | 0.72 (0.62–0.84) | P < 0.001 | |
| All-cause death, group 4Group 4vs Group 1 | 0.80 (0.73–0.87) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
Original publication
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. Cardiovasc Diabetol. Published 30 January 2023. doi:10.
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