Predictors of sudden cardiac death in atrial fibrillation: The Atherosclerosis Risk in Communities (ARIC) study

• Type of Material: Article
• Authors: Ryan J. Koene, University of Minnesota; Faye L. Norby, University of Minnesota; Ankit Maheshwari, University of Minnesota; Mary R. Rooney, University of Minnesota; Elsayed Z. Soliman, Wake Forest School of Medicine; Alvaro Alonso, Emory University; Lin Y. Chen, University of Minnesota
• Language: English
• Date: 2017-11-08
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2017 Koene et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0187659
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 12
• Issue: 11
• Start Page: e0187659
• End Page: e0187659
• Grant/Funding Information: SCD adjudication in ARIC was supported by the Donald W. Reynolds Foundation.; Additional support was provided by American Heart Association grant 16EIA2641000.; The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C).
• Keywords: Science & Technology - Other Topics; POPULATION; MORTALITY; CARDIOVASCULAR-DISEASE; Science & Technology; ASSOCIATION; Multidisciplinary Sciences; SERUM-ALBUMIN; CORONARY HEART-DISEASE; CYCLE LENGTH; COMPETING-RISK; PREVALENCE; FAILURE
• Research Categories: Health Sciences, Public Health; Health Sciences, General

Abstract

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. We previously reported that incident atrial fibrillation (AF) is associated with an increased risk of sudden cardiac death (SCD) in the general population. We now aimed to identify predictors of SCD in persons with AF from the Atherosclerosis Risk in Communities (ARIC) study, a community-based cohort study. We included all participants who attended visit 1 (1987–89) and had no prior AF (n = 14,836). Incident AF was identified from study electrocardiograms and hospitalization discharge codes through 2012. SCD was physician-adjudicated. We used cause-specific Cox proportional hazards models, followed by stepwise selection (backwards elimination, removing all variables with p > 0.10) to identify predictors of SCD in participants with AF. AF occurred in 2321 (15.6%) participants (age 45–64 years, 58% male, 18% black). Over a median of 3.3 years, SCD occurred in 110 of those with AF (4.7%). Predictors of SCD in AF included higher age, body mass index (BMI), coronary heart disease, hypertension, diabetes, current smoker, left ventricular hypertrophy, increased heart rate, and decreased albumin. Predictors associated only with SCD and not other cardiovascular (CV) death included increased BMI (HR per 5-unit increase, 1.15, 95% CI, 0.97–1.36, p = 0.10), increased heart rate (HR per SD increase, 1.18, 95% CI 0.99–1.41, p = 0.07), and low albumin (HR per SD decrease 1.23, 95% CI 1.02–1.48, p = 0.03). In the ARIC study, predictors of SCD in AF that are not associated with non-sudden CV death included increased BMI, increased heart rate, and low albumin. Further research to confirm these findings in larger community-based cohorts and to elucidate the underlying mechanisms to facilitate prevention is warranted.