Association between exercise habits and stroke, heart failure, and mortality in Korean patients with incident atrial fibrillation: A nationwide population-based cohort study - PubMed (original) (raw)

Observational Study

Association between exercise habits and stroke, heart failure, and mortality in Korean patients with incident atrial fibrillation: A nationwide population-based cohort study

Hyo-Jeong Ahn et al. PLoS Med. 2021.

Abstract

Background: There is a paucity of information about cardiovascular outcomes related to exercise habit change after a new diagnosis of atrial fibrillation (AF). We investigated the association between exercise habits after a new AF diagnosis and ischemic stroke, heart failure (HF), and all-cause death.

Methods and findings: This is a nationwide population-based cohort study using data from the Korea National Health Insurance Service. A retrospective analysis was performed for 66,692 patients with newly diagnosed AF between 2010 and 2016 who underwent 2 serial health examinations within 2 years before and after their AF diagnosis. Individuals were divided into 4 categories according to performance of regular exercise, which was investigated by a self-reported questionnaire in each health examination, before and after their AF diagnosis: persistent non-exercisers (30.5%), new exercisers (17.8%), exercise dropouts (17.4%), and exercise maintainers (34.2%). The primary outcomes were incidence of ischemic stroke, HF, and all-cause death. Differences in baseline characteristics among groups were balanced considering demographics, comorbidities, medications, lifestyle behaviors, and income status. The risks of the outcomes were computed by weighted Cox proportional hazards models with inverse probability of treatment weighting (IPTW) during a mean follow-up of 3.4 ± 2.0 years. The new exerciser and exercise maintainer groups were associated with a lower risk of HF compared to the persistent non-exerciser group: the hazard ratios (HRs) (95% CIs) were 0.95 (0.90-0.99) and 0.92 (0.88-0.96), respectively (p < 0.001). Also, performing exercise any time before or after AF diagnosis was associated with a lower risk of mortality compared to persistent non-exercising: the HR (95% CI) was 0.82 (0.73-0.91) for new exercisers, 0.83 (0.74-0.93) for exercise dropouts, and 0.61 (0.55-0.67) for exercise maintainers (p < 0.001). For ischemic stroke, the estimates of HRs were 10%-14% lower in patients of the exercise groups, yet differences were statistically insignificant (p = 0.057). Energy expenditure of 1,000-1,499 MET-min/wk (regular moderate exercise 170-240 min/wk) was consistently associated with a lower risk of each outcome based on a subgroup analysis of the new exerciser group. Study limitations include recall bias introduced due to the nature of the self-reported questionnaire and restricted external generalizability to other ethnic groups.

Conclusions: Initiating or continuing regular exercise after AF diagnosis was associated with lower risks of HF and mortality. The promotion of exercise might reduce the future risk of adverse outcomes in patients with AF.

PubMed Disclaimer

Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: HJA, SRL, KDH, JHJ, JHL, JPY, SK, SO: None to disclose. EKC: Research grants from Bayer, BMS/Pfzer, Biosense Webster, Chong Kun Dang, Daiichi-Sankyo, Samjinpharm, Sanof-Aventis, Seers Technology, Skylabs, and Yuhan. GYHL: Consultant for Bayer/Janssen, BMS/Pfzer, Medtronic, Boehringer Ingelheim, Novartis, Verseon and Daiichi-Sankyo. Speaker for Bayer, BMS/Pfzer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are received personally. The external funders and sponsors of the study had no role in study design and conduct of the study; in the collection, analysis, and interpretation of the data; in the preparation, review, or approval of the manuscript; or in the decision to submit the manuscript for publication.

Figures

Fig 1

Fig 1. Selection and categorization of the study population.

(A) Selection of study population from the National Health Insurance Service. (B) Categorization of study population according to the change of exercise status and overall scheme of study, including clinical outcomes. AF, atrial fibrillation; CHF, congestive heart failure.

Fig 2

Fig 2. Hazard ratios with 95% confidence intervals for ischemic stroke, heart failure, and all-cause death according to the change of exercise status.

The bars denote weighted incidence rates, the dots denote hazard ratios, and the whiskers denote 95% confidence intervals computed by weighted Cox proportional hazards models with inverse probability of treatment weighting.

Fig 3

Fig 3. Hazard ratios with 95% confidence intervals for ischemic stroke, heart failure, and all-cause death in the new exerciser group (No to Yes) according to energy expenditure (MET-min/wk).

The bars denote weighted incidence rates, the dots denote hazard ratios, and the whiskers denote 95% confidence intervals computed by weighted Cox proportional hazards models with inverse probability of treatment weighting. MET, metabolic equivalent of task.

References

    1. Weng LC, Preis SR, Hulme OL, Larson MG, Choi SH, Wang B, et al. Genetic predisposition, clinical risk factor burden, and lifetime risk of atrial fibrillation. Circulation. 2018;137(10):1027–38. doi: 10.1161/CIRCULATIONAHA.117.031431 - DOI - PMC - PubMed
    1. Lee SR, Choi EK, Han KD, Cha MJ, Oh S. Trends in the incidence and prevalence of atrial fibrillation and estimated thromboembolic risk using the CHA2DS2-VASc score in the entire Korean population. Int J Cardiol. 2017;236:226–31. doi: 10.1016/j.ijcard.2017.02.039 - DOI - PubMed
    1. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837–47. doi: 10.1161/CIRCULATIONAHA.113.005119 - DOI - PMC - PubMed
    1. Ruddox V, Sandven I, Munkhaugen J, Skattebu J, Edvardsen T, Otterstad JE. Atrial fibrillation and the risk for myocardial infarction, all-cause mortality and heart failure: a systematic review and meta-analysis. Eur J Prev Cardiol. 2017;24(14):1555–66. doi: 10.1177/2047487317715769 - DOI - PMC - PubMed
    1. Rahman F, Kwan GF, Benjamin EJ. Global epidemiology of atrial fibrillation. Nat Rev Cardiol. 2014;11(11):639–54. doi: 10.1038/nrcardio.2014.118 - DOI - PubMed

Publication types

MeSH terms

LinkOut - more resources