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Patients with atrial fibrillation (AF) aged younger than 65 years have substantial comorbidity burden—especially obesity, heart failure (HF), and hypertension (HTN)—that may impact their future risk of mortality, according to new research.¹

Findings from the large real-world study also showed that adults with AF who are less than 65 years of age are at a significantly increased risk of hospitalization for HF, stroke, and myocardial infarction (MI) compared to similarly aged and gender-matched participants who did not have AF.¹

“Common knowledge among cardiologists is that, in people under 65, Afib is extremely uncommon and not detrimental. But there really hasn’t been any data to back that up,” said lead author Aditya Bhonsale, MD, MHS, cardiac electrophysiologist, University of Pittsburgh Medical Center (UPMC), assistant professor of medicine, University of Pittsburgh, in a university press release.²

Bhonsale continued: “At UPMC, we've been seeing a lot more young patients with Afib in recent years and have been interested in understanding the real-world clinical course of these individuals. As a payer-provider with patient records across more than 40 hospitals, UPMC was uniquely positioned to ask this question, which no one has been able to ask before.”²

Bhonsale and colleagues conducted the current study to examine the risk factor (RF) burden, clinical course, and long-term outcomes among patients aged less than 65 years with AF using UPMC-wide electronic health records and administrative data.¹

“We additionally examined the association of AF with mortality among these patients utilizing national survival estimates and a contemporary internal cohort of patients without a diagnosis of AF,” wrote investigators in Circulation Arrhythmia and Electrophysiology.¹

The study included patients aged 18 years and older who had at least 2 outpatient visits at the UPMC with an associated diagnosis of AF. Participants were evaluated between January 4, 2010, and December 31, 2019, according to the study.¹

The primary outcome was all-cause mortality and secondary outcomes included hospitalization for cardiovascular causes, MI, AF, HF, stroke, or major bleeding.¹

FINDINGS¹

Based on electronic health records for a total of 67 221 patients who sought care for AF (mean age, 72.4 years; 45% women; 95% White), more than one-quarter (26%, n=17 335) were aged less than 65 years at initial evaluation (32% women) and included in the researchers’ analysis. The proportion of 26% was a “stark contrast” to the 2% prevalence of AF commonly estimated among adults younger than 65 years, noted the press release.² Cardiovascular RF burden was considerable in this group. More than 20% of individuals had significant obesity, 16% were current smokers, 55% had HTN, 21% had diabetes, 20% had HF, 19% had coronary artery disease, and 6% had prior ischemic stroke. Also, more than half (55%) were receiving anticoagulants, noted researchers.

The burden of noncardiovascular comorbidities was also high in individuals aged less than 65 years with AF, with 18% experiencing obstructive sleep apnea, 11% having chronic obstructive pulmonary disease, and 1.3% having chronic kidney disease.

Mortality and hospitalization. Over a mean follow-up of more than 5 years, 6.7% (n=204) of patients aged less than 50 years and 13.1% (n=1880) of patients aged 50-65 years died. The proportion of patients with more than 1 hospitalization for HF, MI, and stroke was 1.3%, 4.8%, and 1.1% for those aged less than 50 years and 2.2%, 7.4%, and 1.1% for those aged 50-65 years, respectively.

Clinical factors linked to all-cause mortality. According to researchers, multiple cardiac and noncardiac RFs were associated with increased mortality in patients aged less than 65 years with AF, with HF and HTN demonstrating significant age-related interaction (P = .007 and P = .013, respectively).

When investigators compared patients with AF aged less than 65 years with an internal control population of 918 073 persons without AF, they found that men and women with AF experienced significantly worse survival:

• Men aged <50 years: HR 1.5, 95% CI 1.24-1.79
• Men aged 50-65 years: HR 1.3, 95% CI 1.26-1.43
• Women aged <50 years: HR 2.4, 95% CI 1.82-3.16
• Women aged 50-65 years: HR 1.7, 95% CI 1.6-1.92

“The results of our study suggest that management of patients with atrial fibrillation aged <65 years must be in the context of their individual cardiovascular risk factors burden and lifestyle modification with an appropriate focus on noncardiac risk factors,” wrote Bhonsale et al.

References:

1. Bhonsale A, Zhu J, Thoma F, et al. Mortality, hospitalization, and cardiac interventions in patients with atrial fibrillation aged <65 years. Circ Arrhythm Electrophysiol. Published online April 22, 2024. doi:10.1161/CIRCEP.123.012143
2. Afib more common and dangerous in younger people than previously thought. News release. University of Pittsburgh Medical Center. April 22, 2024. Accessed April 23, 2024. https://www.upmcphysicianresources.com/news/042224-afib