title: Multimorbidity and the risk of hospitalization and death in atrial fibrillation: A population-based study.
abstract: Patients with atrial fibrillation (AF) have many comorbidities and excess risks of hospitalization and death. Whether the impact of comorbidities on outcomes is greater in AF than the general population is unknown.
  
  
  METHODS
  One thousand four hundred thirty patients with AF and community controls matched 1:1 on age and sex were obtained from Olmsted County, Minnesota. Andersen-Gill and Cox regression estimated associations of 19 comorbidities with hospitalization and death, respectively.
  
  
  RESULTS
  AF cases had a higher prevalence of most comorbidities. Hypertension (25.4%), coronary artery disease (17.7%), and heart failure (13.3%) had the largest attributable risk of AF; these along with obesity and smoking explained 51.4% of AF. Over a mean follow-up of 6.3 years, patients with AF experienced higher rates of hospitalization and death than did population controls. However, the impact of comorbidities on hospitalization and death was generally not greater in patients with AF compared with controls, with the exception of smoking. Ever smokers with AF experienced higher-than-expected risks of hospitalization and death, with observed vs expected (assuming additivity of effects) hazard ratios compared with never smokers without AF of 1.78 (1.56-2.02) vs 1.52 for hospitalization and 2.41 (2.02-2.87) vs 1.84 for death.
  
  
  CONCLUSIONS
  Patients with AF have a higher prevalence of most comorbidities; however, the impact of comorbidities on hospitalization and death is generally similar in AF and controls. Smoking is a notable exception; ever smokers with AF experienced higher-than-expected risks of hospitalization and death. Thus, interventions targeting modifiable behaviors may benefit patients with AF by reducing their risk of adverse outcomes.
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN. Electronic address: chamberlain.alanna@mayo.edu.
authors.forename: Alanna M
authors.initials: AM
authors.lastname: Chamberlain
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Manemann
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Killian
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Weston
authors.affiliation: Corner Home Medical, New Hope, MN.
authors.forename: Margaret
authors.initials: M
authors.lastname: Byrne
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Véronique L
authors.initials: VL
authors.lastname: Roger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000453:epidemiology; D001249:Asthma / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000453:epidemiology*; D002423:Cause of Death; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D003704:Dementia / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009026:Mortality; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D010024:Osteoporosis / Q000453:epidemiology; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology