AFib patients with diabetes have higher risk of death—but not bleeding events

Diabetic patients with atrial fibrillation (AFib) have a lower quality of life and are at increased risk of death and hospitalization. However, they are no more likely than other AFib patients to have thromboembolic or bleeding events, despite higher intake of anticoagulants, according to new research.

In AFib patients less than 70 years old, diabetes was associated with a 63 percent increase in total mortality at two years of follow-up and a 120 percent increase in cardiovascular mortality. Diabetic patients also demonstrated a higher incidence of sudden cardiac death and hospitalization.

“Although the association of diabetes and incident AF (AFib) has been reported in several community-based and hospital-based studies, a limited number of studies have evaluated the association between diabetes and clinical outcomes among individuals with AF,” lead researcher Justin B. Echouffo-Tcheugui, MD, Harvard Medical School, and colleagues wrote in the Journal of the American College of Cardiology. “The present study demonstrated that, even after extensive covariate adjustment, diabetes is independently associated with an increased risk of all-cause and CV mortality in community-based patients with AFib.”

The researchers tracked 9,749 adult AFib patients, 30 percent of whom had diabetes. Participants were followed at six-month intervals for up to three years.

In an accompanying editorial, three doctors wrote the mortality rates in the diabetes sample were “sobering” but not surprising. However, they interpreted the similar bleeding rates between the two groups as reason for optimism.

“These findings from real-world clinical practice suggest that more aggressive use of anticoagulants in the treatment of patients with diabetes and concomitant AFib appears to have a favorable risk-benefit balance,” wrote lead author Zachary T. Bloomgarden, MD, Icahn School of Medicine at Mount Sinai, New York.

In addition, the patients with diabetes didn’t show a greater risk for AFib progression or incident heart failure, although they were, on average, at more advanced stages of both conditions at baseline.

Echouffo-Tcheugui et al. acknowledged they could have underestimated the diabetic population in the study. Patients who had a pre-hospitalization history of diabetes and weren’t screened during their study visit may have been miscategorized. Also, the following factors were unknown by the researchers: cause of death, degree of glycemic control and pretrial duration of diabetes.