Symptoms of Atrial Fibrillation More Likely to Go Unreported, Unrecognized in Diabetes

This article was originally published on EndocrinologyNetwork.com.

Tobias Reichlin, MD

A recent analysis of data from the SWISS-AF study suggests patients with diabetes were less likely to perceive symptoms of atrial fibrillation than their counterparts without diabetes.

Results of the analysis, which included data from more than 2400 patients, provide clinicians with insight into the lower likelihood of reporting arrhythmias as well as the prevalence of cardiovascular and neurologic comorbidities among these patients.

“Since diabetes is one of the major risk factors for AFib, our team investigated whether patients with and without diabetes differ in terms of atrial fibrillation symptoms and complications,” said study author Tobias Reichlin, MD, professor of cardiology at Bern University Hospital at the University of Bern in Switzerland, in a statement. “This research can provide insights on improving the management of atrial fibrillation and prevention of its complications.”

The current study was designed by Reichlin and a team of colleagues with an interest in assessing potential associations of diabetes with parameters of AF phenotype, including AF type, AF symptoms, and quality of life. Using the ongoing SWISS-AF study, investigators obtained information related to 2415 patients, of which 2411 had complete data on history of diabetes and AF phenotype. Of the 2411 included in the investigators’ analyses, 420 had known diabetes, the mean age at baseline was 73.2 years, and 27.4% were women.

Compared to those without diabetes, patients with diabetes were more likely to be older, men, smokers, and have a higher body mass index. Additionally, patients with diabetes had a greater stroke risk, which was assessed according to median CHA2DS2-VASC.

The primary outcomes of interest for the study were parameters of AF phenotype, AF symptoms, and quality of life. Secondary outcomes of interest for the study included cardiac and neurological comorbidities. For the purpose of analysis, neurological morbidities included history of stroke and cognitive impairment while cardiac comorbidities included hypertension, myocardial infarction, and heart failure. Quality

Investigators planned to assess cross-sectional associations of diabetes with the aforementioned outcomes using logistic and linear regression, adjusted for age, sex, and cardiovascular risk factors.

Results of the investigators’ analyses indicated diabetes was not associated with increased likelihood of nonparoxysmal (OR, 1.01; 95% CI, 0.81-1.27). Further analysis suggested patients with diabetes were less likely to perceive AF symptoms (OR, 0.74; 95% CI, 0.59-0.92) and had a lower quality of life (β=−4.54; 95% CI, −6.40 to −2.68) than their counterparts without diabetes.

When assessing presence of comorbidities, patients with diabetes were more likely to have hypertension (OR, 3.04; 95% CI, 2.19-4.22), myocardial infarction (OR, 1.55; 95% CI, 1.18-2.03), and heart failure (OR, 1.99; 95% CI, 1.57-2.51) than those without diabetes. Additionally, patients with diabetes were also more likely to report neurological comorbidities, with increased likelihood observed for both stroke (OR, 1.39; 95% CI, 1.03-1.87) and cognitive impairment (OR, 1.75; 95% CI, 1.39-2.21)

”These important new findings from the large Swiss AF study show compared to AFib patients without diabetes, those with diabetes were less likely to experience any symptom related to atrial fibrillation,” said Prakash Deedwania, MD, a member of the scientific advisory board for Know Diabetes By Heart (KDBH), a joint initiative of the American Heart Association and the American Diabetes Association and a professor of medicine at the University of California, San Francisco School of Medicine. “These results were seen even though people with diabetes and AFib had more coexisting health conditions such as high blood pressure, as well as a history of heart attack and heart failure. Keeping these new observations in mind, along with the serious consequences of failing to recognize AFib in time, it seems prudent to consider screening older patients with diabetes for AFib so that treatment may be initiated when appropriate."

This study, “Association of Diabetes With Atrial Fibrillation Phenotype and Cardiac and Neurological Comorbidities: Insights From the Swiss‐AF Study,” was published in the Journal of the American Heart Association.