Arrhythmias and conduction disturbance
Prevalence, Functional Impact, and Mortality of Atrial Fibrillation in an Older Italian Population (from the Pro.V.A. Study)

https://doi.org/10.1016/j.amjcard.2009.05.058Get rights and content

The prevalence of atrial fibrillation (AF) is increasing in older patients faster than that of any other arrhythmia. AF is associated with increased morbidity and mortality. Data on AF in European populations are scarce. The aim of this study was to determine the prevalence and potential predictors of AF and to assess its impact on physical function and mortality in a representative sample of an Italian population ≥65 years of age. One thousand five hundred ninety-nine participants in the Pro.V.A. study, an observational cohort study of Italian subjects ≥65 years old, were assessed for health status, disability, and presence of AF at baseline and at a 4-year follow-up visit. After weighting, prevalence of AF at baseline was 7.4% and increased with advancing age. In subjects with AF, prevalences of stroke, coronary heart disease, peripheral artery disease, cognitive impairment, and physical disability were significantly higher (p <0.01) than in those without AF. In patients with AF, 34% had heart failure compared to 5.3% of those without AF (p <0.0001). In multivariate logistic regression, heart failure was associated with a fivefold risk of AF (odds ratio 5.09, 95% confidence interval 3.20 to 8.11). In Cox analysis, AF was an independent risk factor for mortality. After adjustment for potential confounders, the hazard ratio for mortality associated with AF was 1.47 (95% confidence interval 1.08 to 1.99). In conclusion, in subjects ≥65 years old, AF is strongly associated with heart failure, is an independent risk factor for mortality, and, in the presence of physical disability, could be considered a severity measurement of disability.

Section snippets

Methods

The Pro.V.A. study is an observational cohort study of an Italian population ≥65 years of age living in the community in 2 separate geographic areas of northeastern Italy. Study design, sample characteristics, and protocol have been published.1, 2 Briefly, the study population was sampled from all subjects ≥65 years old living in Camposampiero and Rovigo, 2 small cities surrounded by rural and industrial areas. No exclusion criteria were used. In the 2 areas, the proportion of inhabitants >65

Results

Demographic and baseline characteristics by gender are presented in Table 1. Mean ages were 77 ± 8 in men and 76 ± 7 in women.

ECGs were obtained from all 1,599 subjects at baseline and at follow-up (mean time 4 years). Of these, 23 were not readable because of technical reasons; the final analysis, therefore, was performed in 1,576 subjects. Overall, the weighted prevalence of AF was 7.4% and increased with advancing age (Table 2). At follow-up, 65 new cases of AF were registered, corresponding

Discussion

AF is the most prevalent arrhythmia affecting the general population, with a higher prevalence in older patients, and is a major determinant of quality of life and disability and a considerable source of morbidity and mortality.4

Most previous studies exploring AF and its impact on morbidity/mortality in older subjects have been performed in the United States or northern Europe. Very few studies have been done in a prospective population-based setting, whereas others have focused on hospitalized

Acknowledgment

This study was designed in collaboration with the University of Padua and local health units 15 and 18 of the Veneto Region. We are thankful to all personnel who collaborated in the data collection and analysis and to all participants.

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    This work was funded by Fondazione Cassa di Risparmio di Padova e Rovigo, Padua, Italy.

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