Association of kidney function and atrial fibrillation progression to clinical outcomes in patients with cardiac implantable electronic devices

Am Heart J. 2021 Nov:241:6-13. doi: 10.1016/j.ahj.2021.06.002. Epub 2021 Jun 10.

Abstract

Background: Kidney function may promote progression of AF.

Objective: We evaluated the association of kidney function to AF progression and resultant clinical outcomes in patients with cardiac implantable electronic devices (CIED).

Methods: We performed a retrospective cohort study using national clinical data from the Veterans Health Administration linked to CIED data from the Carelink® remote monitoring data warehouse (Medtronic Inc, Mounds View, MN). All devices had atrial leads and at least 75% of remote monitoring transmission coverage. Patients were included at the date of the first AF episode lasting ≥6 minutes, and followed until the occurrence of persistent AF in the first year, defined as ≥7 consecutive days with continuous AF. We used Cox regression analyses with persistent AF as a time-varying covariate to examine the association to stroke, myocardial infarction, heart failure and death.

Results: Of, 10,323 eligible patients, 1,771 had a first CIED-detected AF (mean age 69 ± 10 years, 1.2% female). In the first year 355 (20%) developed persistent AF. Kidney function was not associated with persistent AF after multivariable adjustment including CHA2DS2-VASc variables and prior medications. Only higher age increased the risk (HR: 1.37 per 10 years; 95% CI:1.22-1.54). Persistent AF was associated to higher risk of heart failure (HR: 2.27; 95% CI: 1.88-2.74) and death (HR: 1.60; 95% CI: 1.30-1.96), but not stroke (HR: 1.28; 95% CI: 0.62-2.62) or myocardial infarction (HR: 1.43; 95% CI: 0.91-2.25).

Conclusion: Kidney function was not associated to AF progression, whereas higher age was. Preventing AF progression could reduce the risk of heart failure and death.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / mortality
  • Atrial Fibrillation* / physiopathology
  • Correlation of Data
  • Electrodes, Implanted / statistics & numerical data
  • Female
  • Heart Failure* / diagnosis
  • Heart Failure* / epidemiology
  • Humans
  • Kidney Function Tests* / methods
  • Kidney Function Tests* / statistics & numerical data
  • Male
  • Monitoring, Physiologic* / instrumentation
  • Monitoring, Physiologic* / methods
  • Monitoring, Physiologic* / statistics & numerical data
  • Negative Results
  • Remote Sensing Technology / instrumentation
  • Remote Sensing Technology / statistics & numerical data
  • Risk Assessment / methods
  • Risk Assessment / statistics & numerical data
  • Risk Factors
  • Stroke* / diagnosis
  • Stroke* / epidemiology
  • United States / epidemiology
  • Veterans Health / statistics & numerical data