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Long‐term individual and population functional outcomes in older adults with atrial fibrillation
Author(s) -
Parks Anna L.,
Jeon Sun Y.,
Boscardin W. John,
Steinman Michael A.,
Smith Alexander K.,
Fang Margaret C.,
Shah Sachin J.
Publication year - 2021
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.17087
Subject(s) - medicine , activities of daily living , stroke (engine) , atrial fibrillation , gerontology , population , logistic regression , independent living , residence , physical therapy , demography , environmental health , mechanical engineering , sociology , engineering
Background Older adults with atrial fibrillation (AF) have multiple risk factors for disablement. Long‐term function and the contribution of strokes to disability have not been previously characterized. Our objective was to determine long‐term function among older adults with AF and the relative contribution of stroke. Methods We used data from the nationally representative Health and Retirement Study (1992–2014) with participants ≥65 years with incident AF. We examined the association of incident stroke with three outcomes: independence with activities of daily living (ADL), instrumental activities of daily living (IADL), and residence outside a nursing home (community‐dwelling). We fit logistic regression models with repeated measures adjusting for comorbidities and demographics to estimate the effect of stroke on function. We estimated the contribution of strokes to the overall population burden of disability using the method of recycled predictions. Results Among 3530 participants (median age 79 years, 53% women), 262 had a stroke over 17,396 person‐years. Independent of stroke and accounting for comorbidities, annually, ADL independence decreased by 4.4%, IADL independence decreased by 3.9%, and community dwelling decreased by 1.2% ( p < 0.05 for all). Accounting for comorbidities, of those who experienced a stroke, 31.9% developed new ADL dependence, 26.5% developed new IADL dependence, and 8.6% newly moved to a nursing home ( p < 0.05 for all). Considering all causes of function loss, 1.7% of ADL disability‐years, 1.2% of IADL disability‐years, and 7.3% of nursing home years could be attributed to stroke over 7.4 years. Conclusion Older adults lose substantial function over time following AF diagnosis, independent of stroke. Stroke was associated with a significant functional decline and increase in the likelihood of nursing home move, but stroke did not accelerate subsequent disability accrual. Because of the high background rate of disability, stroke was not the dominant determinant of population‐level disability in older adults with AF.