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Traumatic injury and atrial fibrillation among deployed service members
Author(s) -
Alcover Karl C.,
Ambardar Shiva R.,
Poltavskiy Eduard,
Nasir Javed M.,
Janak Jud C.,
Howard Jeffrey T.,
Walker Lauren E.,
Haigney Mark C.,
Stewart Ian J.
Publication year - 2021
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.15139
Subject(s) - medicine , atrial fibrillation , emergency medicine , confidence interval , retrospective cohort study , incidence (geometry) , veterans affairs , atrial flutter , injury prevention , cohort , injury severity score , poison control , cardiology , physics , optics
Abstract Introduction Atrial fibrillation and atrial flutter (AF/AFL), the most common atrial arrhythmias, have never been examined in combat casualties. In this study, we investigated the impact of traumatic injury on AF/AFL among service members with deployment history. Methods Sampled from the Department of Defense (DoD) Trauma Registry ( n = 10,000), each injured patient in this retrospective cohort study was matched with a non‐injured service member drawn from the Veterans Affairs/DoD Identity Repository. The primary outcome was AF/AFL diagnosis identified using ICD‐9‐CM and ICD‐10‐CM codes. Competing risk regressions based on Fine and Gray subdistribution hazards model with were utilized to assess the association between injury and AF/AFL. Results There were 130 reported AF/AFL cases, 90 of whom were injured and 40 were non‐injured. The estimated cumulative incidence rates of AF/AFL for injured was higher compared to non‐injured patients (hazards ratio [HR] = 2.04; 95% confidence interval [CI] = 1.44, 2.87). After adjustment demographics and tobacco use, the association did not appreciably decrease (HR = 1.90; 95% CI = 1.23, 2.93). Additional adjustment for obesity, hypertension, diabetes, and vascular disorders, the association between injury and AF/AFL was no longer statistically significant (HR = 1.51; 95% CI = 0.99, 2.52). Conclusion Higher AF/AFL incidence rate was observed among deployed service members with combat injury compared to servicemembers without injury. The association did not remain significant after adjustment for cardiovascular‐related covariates. These findings highlight the need for combat casualty surveillance to further understand the AF/AFL risk within the military population and to elucidate the potential underlying pathophysiologic mechanisms.