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Association of changes in cardiovascular health levels with incident cardiovascular events and mortality in patients with atrial fibrillation

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Abstract

Background

Risk factor management is crucial in the management of atrial fibrillation (AF). We investigated the association of changes in cardiovascular health (CVH) levels after AF diagnosis with incident cardiovascular events and mortality.

Methods

From the Korea National Health Insurance Service database, 76,628 patients newly diagnosed with AF (2005–2015) with information on health examinations before and after AF diagnosis were assessed. According to the change in the 12-point CVH score before and after AF diagnosis, patients were stratified into four groups: consistently low (score 0–7 to 0–7), high-to-low (8–12 to 0–7), low-to-high (0–7 to 8–12), and consistently high (8–12 to 8–12) CVH levels. Risks of cardiovascular events and death were analyzed using weighted Cox regression models with inverse probability of treatment weighting (IPTW) for balance across study groups.

Results

The mean age of study participants was 58.3 years, 50,285 were men (63.1%), and the mean follow-up was 5.5 years. After IPTW, low-to-high (hazard ratio [95% confidence interval], 0.83 [0.76–0.92]) and consistently high (0.80 [0.74–0.87]) CVH levels were associated with a lower risk of ischemic stroke than consistently low CVH. Low-to-high (0.66 [0.52–0.84]) and consistently high (0.52 [0.42–0.64]) CVH levels were associated with a lower risk of acute myocardial infarction. Maintaining high CVH was associated with reduced risks of heart failure hospitalization (0.85 [0.75–0.95]) and all-cause death (0.82 [0.77–0.88]), respectively, compared with consistently low CVH.

Conclusions

Improving CVH levels and maintaining high CVH levels after AF diagnosis is associated with lower risks of subsequent cardiovascular events and mortality.

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Data and materials availability

All raw data are accessible from the designated terminals approved by the National Health Insurance Sharing Service (https://nhiss.nhis.or.kr/).

Abbreviations

AF:

Atrial fibrillation

AHA:

The American Heart Association

ASD:

Absolute standardized difference

BP:

Blood pressure

CCI:

Charlson comorbidity index

CI:

Confidence interval

CKD:

Chronic kidney disease

COPD:

Chronic obstructive pulmonary disease

CVD:

Cardiovascular disease

CVH:

Cardiovascular health

HF:

Heart failure

HR:

Hazard ratio

ICD-10:

The International Classification of Diseases-10th revision

IPTW:

Inverse probability of treatment weighting

MI:

Myocardial infarction

NHID:

The National Health Information Database

NHIS:

The National Health Insurance Service of Korea

PAD:

Peripheral artery disease

PY:

Person-years

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Acknowledgements

Access to the NHID was provided by the NHIS of Korea. The authors would like to thank the NHIS for their cooperation.

Funding

This research was supported by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC19C0130). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Author notes

  1. Seunghoon Cho and Pil-Sung Yang equally contributed to this work.

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea

    Seunghoon Cho, Daehoon Kim, Eunsun Jang, Hee Tae Yu, Tae-Hoon Kim, Hui-Nam Pak, Moon-Hyoung Lee & Boyoung Joung

  2. Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea

    Pil-Sung Yang & Jung-Hoon Sung

  3. Department of Biomedical Informatics, Yonsei University, Seoul, Republic of Korea

    Seng Chan You

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  1. Seunghoon Cho
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Contributions

BJ and P-SY contributed to the conceptualization and design of the work, project administration, and critical revision of the manuscript. SC contributed to the conception and design of the work, and analysis, interpretation, and visualization of data for the work, and original drafting of the manuscript. P-SY and EJ contributed to the acquisition and analysis of data for the work. P-SY, DK, SCY, and BJ contributed to the supervision and validation of the work. DK, SCY, J-HS, HTY, T-HK, H-NP, and M-HL contributed to reviewing and revising the manuscript. All the authors approved the final version of the manuscript.

Corresponding author

Correspondence to Boyoung Joung.

Ethics declarations

Conflict of interest

Dr. Boyoung Joung has served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi-Sankyo and received research funds from Medtronic and Abbott. None of the other authors have any disclosures to declare. No fees were directly or personally received. The other authors have nothing to declare.

Ethics approval

This study was approved by the Institutional Review Board of the Yonsei University Health System (4-2021-1357). This study was conducted in compliance with the ethical guidelines of the Declaration of Helsinki.

Consent to participate and publish

The requirement for informed consent was waived because this study used anonymous data.

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Cho, S., Yang, PS., Kim, D. et al. Association of changes in cardiovascular health levels with incident cardiovascular events and mortality in patients with atrial fibrillation. Clin Res Cardiol 112, 724–735 (2023). https://doi.org/10.1007/s00392-022-02058-3

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