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From the National Heart, Lung, and Blood Institute's Framingham
Heart Study, National Institutes of Health, Framingham, Mass (E.J.B., P.A.W.,
R.B.D., H.S., W.B.K., D.L.); Departments of Cardiology (E.J.B.), Preventive
Medicine (E.J.B., P.A.W., D.L.), and Neurology (P.A.W.), Boston University
School of Medicine, Boston, Mass; Department of Mathematics, Boston University
(R.B.D., H.S.), Boston, Mass; Division of Cardiology and Clinical
Epidemiology, Beth Israel Hospital, Boston, Mass (D.L.); and National Heart,
Lung, and Blood Institute, Bethesda, Md (D.L.).
Correspondence to Emelia J. Benjamin, MD, ScM, The Framingham Heart Study, 5 Thurber St, Framingham, MA 01702-6334. E-mail emelia{at}fram.nhlbi.nih.gov
Background—Atrial fibrillation (AF)
causes substantial morbidity. It is uncertain whether AF is associated
with excess mortality independent of associated cardiac conditions and
risk factors.
Methods and Results—We examined the mortality of subjects 55 to
94 years of age who developed AF during 40 years of follow-up of the
original Framingham Heart Study cohort. Of the original 5209 subjects,
296 men and 325 women (mean ages, 74 and 76 years, respectively)
developed AF and met eligibility criteria. By pooled logistic
regression, after adjustment for age, hypertension, smoking, diabetes,
left ventricular hypertrophy, myocardial
infarction, congestive heart failure, valvular heart disease,
and stroke or transient ischemic attack, AF was associated with
an OR for death of 1.5 (95% CI, 1.2 to 1.8) in men and 1.9 (95% CI,
1.5 to 2.2) in women. The risk of mortality conferred by AF did not
significantly vary by age. However, there was a significant AF-sex
interaction: AF diminished the female advantage in survival. In
secondary multivariate analyses, in subjects
free of valvular heart disease and preexisting
cardiovascular disease, AF remained significantly
associated with excess mortality, with about a doubling of mortality in
both sexes.
Conclusions—In subjects from the original cohort of the
Framingham Heart Study, AF was associated with a 1.5- to 1.9-fold
mortality risk after adjustment for the preexisting
cardiovascular conditions with which AF was related.
The decreased survival seen with AF was present in men and women
and across a wide range of ages.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Impact of Atrial Fibrillation on the Risk of Death
The Framingham Heart Study
Key Words: fibrillation, atrial • mortality • prognosis • stroke • cerebrovascular disorders • risk factors • aging
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