title: Incident Atrial Fibrillation and Disability-Free Survival in the Cardiovascular Health Study.
abstract: OBJECTIVE
  To assess the associations between incident atrial fibrillation (AF) and disability-free survival and risk of disability.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Cardiovascular Health Study.
  
  
  METHODS
  Individuals aged 65 and older and enrolled in fee-for-service Medicare followed between 1991 and 2009 (MN = 4,046). Individuals with prevalent AF, activity of daily living (ADL) disability, or a history of stroke or heart failure at baseline were excluded.
  
  
  METHODS
  Incident AF was identified according to annual study electrocardiogram, hospital discharge diagnosis, or Medicare claims. Disability-free survival was defined as survival free of ADL disability (any difficulty or inability in bathing, dressing, eating, using the toilet, walking around the home, or getting out of a bed or chair). ADLs were assessed at annual study visits or in a telephone interview. Association between incident AF and disability-free survival or risk of disability was estimated using Cox proportional hazards models.
  
  
  RESULTS
  Over an average of 7.0 years of follow-up, 660 individuals (16.3%) developed incident AF, and 3,112 (77%) became disabled or died. Incident AF was associated with shorter disability-free survival (hazard ratio (HR) for death or ADL disability = 1.71, 95% confidence interval (CI) = 1.55-1.90) and a higher risk of ADL disability (HR = 1.36, 95% CI = 1.18-1.58) than in individuals with no history of AF. This association persisted after adjustment for interim stroke and heart failure.
  
  
  CONCLUSIONS
  These results suggest that AF is a risk factor for shorter functional longevity in older adults, independent of other risk factors and comorbid conditions.
authors.affiliation: Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington.
authors.forename: Erin R
authors.initials: ER
authors.lastname: Wallace
authors.affiliation: New York Academy of Medicine, New York City, New York.
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Sitlani
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington.|Group Health Research Institute, Group Health Cooperative, Seattle, Washington.
authors.forename: Sascha
authors.initials: S
authors.lastname: Dublin
authors.affiliation: School of Nursing, University of Washington, Seattle, Washington.
authors.forename: Pamela H
authors.initials: PH
authors.lastname: Mitchell
authors.affiliation: College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Odden
authors.affiliation: University of California at Davis Health System, Davis, California.
authors.forename: Calvin H
authors.initials: CH
authors.lastname: Hirsch
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
authors.forename: Stephen
authors.initials: S
authors.lastname: Thielke
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington.|Group Health Research Institute, Group Health Cooperative, Seattle, Washington.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000401:mortality; D004185:Disability Evaluation; D004562:Electrocardiography; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D015994:Incidence; D008136:Longevity; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare; D015995:Prevalence; D011446:Prospective Studies; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
keywords: atrial fibrillation; disability; disability-free survival