Abstract 18282: Atrial Fibrillation Independently Increases Risk of All-Cause Mortality: The Honolulu Heart Program

Abstract

Introduction: Atrial fibrillation (AF) increases cardiovascular and cerebrovascular mortality. However, there are few studies examining the natural history of AF in Asian populations in the US. Objective: To determine the long-term effect of AF detected in mid-life and late-life on all-cause mortality in a population of Japanese-American men.

Methods: The Honolulu Heart Program prospective cohort included Japanese-American males (born 1900-1919) living on O`ahu, Hawai`i in 1965. Analyses included 6,860 and 2,675 participants with electrocardiograms from mid-life and late-life, followed over 36 years and 13 years, respectively. Mid-life AF was defined as having fibrillation or flutter at any of the 3 mid-life exams (ages 45-68 years old) and late-life AF was defined as having fibrillation or flutter at any of 2 late-life exams (ages 71-94 years old). The primary outcome was all-cause mortality.

Results: AF prevalence was 0.74% and 4.36% in mid-life and late-life, respectively, and increased significantly with age (p<0.05), up to 12% in nonagenarians. After adjustment for multiple potential confounders, AF was an independent predictor of mortality in mid-life (RR=1.37, 95% CI=1.03-1.82, p=0.033) and late-life (RR=1.44, 95% CI=1.13-1.83, p=0.003). This relationship remained significant even in those without prevalent coronary heart disease, left ventricular hypertrophy, heart failure, and rheumatic heart disease in both mid-life (RR=1.45, 95% CI=1.04-2.02, p=0.029) and late-life (RR=1.51, 95% CI=1.13-2.02, p=0.005).

Conclusions: In conclusion, atrial fibrillation was a significant independent predictor of all-cause mortality in both mid-life and late-life, including previously healthy participants.