title: Diabetes mellitus as risk factor for atrial fibrillation hospitalization: Incidence and outcomes over nine years in a region of Northern Italy.
abstract: OBJECTIVE
  Diabetes mellitus (DM) and atrial fibrillation (AF) are worldwide public health challenges and major causes of death and cardiovascular events. The association between DM and AF is controversial in literature and data on outcomes of individuals with both diseases have not been evaluated in population studies. We tested the hypothesis that DM is independently associated to AF hospitalization and assessed the risk of stroke and mortality in people with both conditions.
  
  
  METHODS
  We conducted a population-based cohort-study of DM patients and their corresponding controls identified in a administrative health database of the Lombardy Region. Both cohorts were followed for nine years. A multivariable Cox proportional-hazards-regression model was used to estimate the hazard ratio (HR) for first hospitalization for AF and for clinical outcomes.
  
  
  RESULTS
  Out of 9,061,258 residents, 285,428 (3.14%) DM subjects were identified, mean age 65.8±15 years, 49% were women. The cumulative incidence of AF in DM was 10.4% vs. 7.4% in non-DM. DM was a risk factor for AF (HR 1.32, 95% CI 1.30-1.34; p<0.0001). Oral anticoagulants were prescribed in 34.8% of DM patients with AF. DM associated with AF, presented the highest HR for stroke: 2.63; 95% CI 2.47-2.80 and for total death, HR 2.41; 95% CI 2.36-2.47.
  
  
  CONCLUSIONS
  In this population study, DM was an independent risk factor for AF hospitalization. DM patients with AF had the highest risk of stroke and total mortality. Early identification of AF and a structured plan to optimize the comprehensive management of DM and AF patients is mandatory.
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of Cardiovascular Clinical Pharmacology, Milan, Italy. Electronic address: lidia.staszewsky@marionegri.it.
authors.forename: Lidia
authors.initials: L
authors.lastname: Staszewsky
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of General Practice Research, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Cortesi
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of General Practice Research, Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Baviera
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of Geriatric Neuropsychiatry, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Tettamanti
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of General Practice Research, Milan, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Marzona
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory for Quality Assessment of Geriatric Therapies and Services, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Nobili
authors.affiliation: Regional Health Ministry, Lombardy Region, Milan, Italy.
authors.forename: Ida
authors.initials: I
authors.lastname: Fortino
authors.affiliation: Regional Health Ministry, Lombardy Region, Milan, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Bortolotti
authors.affiliation: Regional Health Ministry, Lombardy Region, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Merlino
authors.affiliation: Department of Cardiology, Santa Chiara Hospital, Trento, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Disertori
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of Cardiovascular Clinical Pharmacology, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of General Practice Research, Milan, Italy.
authors.forename: Maria Carla
authors.initials: MC
authors.lastname: Roncaglioni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D003925:Diabetic Angiopathies / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology
keywords: Atrial fibrillation; Diabetes mellitus; Mortality; Population-based cohort study; Stroke