Diabetes mellitus is a strong, independent risk for atrial fibrillation and flutter in addition to other cardiovascular disease

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Abstract

Background

Diabetes mellitus (DM) is a major risk factor for atherosclerosis. There is a controversy in literature about correlation between DM and atrial fibrillation. The goal of this study was to evaluate DM as a risk factor for atrial fibrillation or flutter using a very large database.

Method

Patient treatment files (PTF) containing discharge diagnoses were utilized using ICD-9 codes of inpatient treatment from Veterans Health Administration Hospitals (VAH). Patients with type II DM (ICD-9 code 250.0) (293,124) discharged from the VAH between 1990 and 2000. Non-matched controls without DM but with hypertension (552,624) were selected from the same PTF. By using multi-variate logistic regressions, the occurrence of atrial fibrillation, atrial flutter, CHF, CAD and LVH was compared.

Results

Atrial fibrillations occurred in 43,674 (14.9%) DM patients vs. 57,077 (10.3%) in the control group (p < 0.0001). Atrial flutter occurred in 11,852 (4%) of DM patients vs. 13,554 (2.5%) of the control group (p < 0.0001). Using multi-variant analysis, DM remained independently associated with atrial fibrillation with an OR of 2.13, (95% CI: 2.10 to 2.16; p < 0.0001) and flutter (OR 2.20, CI: 2.15 to 2.26; p < 0.0001). Furthermore, CHF (OR 3.12, CI: 3.09 to 3.16; p < 0.0001), LVH (OR 1.85, CI: 1.77 to 1.92; p < 0.0001) and CAD (OR 2.39, CI: 2.34 to 2.44; p < 0.0001) were also independently associated with DM.

Conclusion

This is the first large-scale study finding DM as a strong, independent risk for the occurrence of atrial fibrillation and flutter and other cardiovascular disease.

Section snippets

Background

Atrial fibrillation is the most common, sustained rhythm disturbance in the United State and counted for 35% of all arrhythmias hospitalized between 1985 and 1990 [1], [2] with a mean cost of $4800 per hospitalization. Its prevalence is increasing along with the age of the population with a prevalence of 0.4% in the general population and less than 6% in those over 80 years old [3], [4]. Atrial fibrillation is often associated with structural heart disease, but a substantial portion of patients

Data collection and data sources

The Austin Automation Center has maintained the Patient Treatment File (PTF) since July 1969. The PTF documents inpatient treatment from all Veterans Health Administration (VHA) hospitals, extended care discharges and non-VHA hospital discharges at the Veterans Administration (VA) expense. The PTF contains demographic characteristics of patients and discharge diagnosis. Since 1984, a primary diagnosis and up to nine secondary diagnoses have been recorded according to the ICD9-CM [18]. This

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