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Cirrhosis is a risk factor for atrial fibrillation: A nationwide, population‐based study
Author(s) -
Lee HyunJung,
Choi EueKeun,
Rhee TaeMin,
Lee SoRyoung,
Lim WooHyun,
Kang SiHyuck,
Han KyungDo,
Cha MyungJin,
Oh Seil
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13459
Subject(s) - atrial fibrillation , medicine , hazard ratio , cirrhosis , confidence interval , incidence (geometry) , cardiology , risk factor , proportional hazards model , population , subgroup analysis , gastroenterology , physics , environmental health , optics
Background & Aims Information is lacking regarding whether cirrhosis is associated with atrial fibrillation development. We aimed to investigate the incidence and clinical significance of atrial fibrillation in cirrhotic patients. Methods Cirrhotic patients (n=3596; mean age, 54.7±12.3 years; male, 72.5%) without previous atrial fibrillation were selected from the Korean National Health Insurance Service National Sample Cohort database between 2004 and 2008. Age‐ and sex‐matched controls (n=17 980) were randomly sampled in a 5:1 ratio from non‐cirrhotic individuals. Both cohorts were followed up for incident atrial fibrillation and death until 2013. Results During 9 years of follow‐up, atrial fibrillation was newly detected in 113 (3.1%) cirrhosis patients and 385 (2.1%) controls (incidence: 3.48 and 2.16 per 1000 person‐years respectively). Cirrhotic patients were at higher risk for atrial fibrillation development compared to controls (hazard ratio, 1.46; 95% confidence interval, 1.18‐1.80) after multivariate adjustment. On subgroup analysis, cirrhosis increased the risk for atrial fibrillation, especially in younger (age younger than 65 years) men without comorbidities ( CHA 2 DS 2 ‐ VAS c score, 0). Cirrhotic patients showed increased overall mortality compared to controls (hazard ratio, 4.80; 95% confidence interval, 4.47‐5.15) as well as increased cardiovascular mortality (hazard ratio, 1.37; 95% confidence interval, 1.07‐1.75). However, there was no significant association between development of atrial fibrillation and increased mortality in cirrhosis patients ( P =.188 and .260). Conclusions Cirrhosis was an independent risk factor for atrial fibrillation development, especially in younger, otherwise healthy men, stressing the importance of cardiac assessment in cirrhotic patients. Meanwhile, atrial fibrillation development in cirrhosis patients was not associated with increased mortality.