Glycemic control and clinical outcomes in patients with diabetes and atrial fibrillation: a nationwide cohort study

IF 3.1 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Acta Diabetologica Pub Date : 2026-06-22 DOI:10.1007/s00592-026-02725-1

Elis Kouki, Birgitta Salmela, Aapo Aro, Olli Halminen, Konsta Teppo, Leo Niskanen, Jari Haukka, Jukka Putaala, Miika Linna, Pirjo Mustonen, Juha Hartikainen, K. E. Juhani Airaksinen, Mika Lehto

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引用次数: 0

Abstract

Aims

To evaluate the association of HbA1c level at the time of atrial fibrillation (AF) diagnosis with adverse outcomes (death, ischemic stroke (IS), myocardial infarction (MI), bleeding) in an unselected nationwide cohort of patients with AF and diabetes mellitus (DM).

Methods

The retrospective FinACAF registry study covered all patients with incident AF in Finland between 2010 and 2017. Outcomes were analyzed using HRs and sHRs (hazard ratios and subdistribution hazard ratios), with HbA1c modelled both categorically and continuously.

Results

Among 157 658 patients with incident AF, DM was present in 23% (n = 35 872). Baseline HbA1c was available in 49% (17 519) of DM patients. DM was associated with increased hazards of all evaluated outcomes. Elevated HbA1c in categorical analyses was associated with progressively increased adjusted HRs and sHRs, with highest ratios seen in HbA1c > 63 mmol/mol for death (HR 1.56, 95% CI 1.45–1.68), IS (sHR 1.38 95% CI 1.20–1.59), and MI (sHR 1.70 95% CI 1.48–1.94), when compared to patients without DM. In continuous analyses, higher HbA1c levels were associated with increasing hazards for mortality, IS, and MI. Bleeding hazards remained stable across the HbA1c spectrum.

Conclusions

Higher baseline HbA1c levels were associated with progressively increased hazards of mortality, IS, and MI in patients with incident AF and DM.

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糖尿病和房颤患者的血糖控制和临床结局：一项全国性队列研究。

目的：在未选择的全国房颤合并糖尿病（DM）患者队列中，评估房颤（AF）诊断时HbA1c水平与不良结局（死亡、缺血性卒中（IS）、心肌梗死（MI）、出血）的关系。方法：回顾性FinACAF登记研究涵盖了2010年至2017年芬兰所有AF事件患者。使用HRs和sHRs（风险比和亚分布风险比）对结果进行分析，并对HbA1c进行分类和连续建模。结果：在157 658例AF患者中，23% （n = 35 872）存在糖尿病。49%（17519）的糖尿病患者可获得基线HbA1c。糖尿病与所有评估结果的风险增加有关。在分类分析中，HbA1c升高与调整后的HR和sHRs逐渐升高相关，与非糖尿病患者相比，HbA1c水平最高的患者为死亡（HR 1.56, 95% CI 1.45-1.68）、IS （sHR 1.38, 95% CI 1.20-1.59）和MI （sHR 1.70, 95% CI 1.48-1.94）。在连续分析中，HbA1c水平升高与死亡率、IS和MI的风险增加相关。在HbA1c谱中，出血风险保持稳定。结论：较高的基线HbA1c水平与AF和DM合并患者的死亡率、IS和MI风险逐渐增加相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Diabetologica 医学-内分泌学与代谢

CiteScore

7.30

自引率

2.60%

发文量

180

审稿时长

2 months

期刊介绍： Acta Diabetologica is a journal that publishes reports of experimental and clinical research on diabetes mellitus and related metabolic diseases. Original contributions on biochemical, physiological, pathophysiological and clinical aspects of research on diabetes and metabolic diseases are welcome. Reports are published in the form of original articles, short communications and letters to the editor. Invited reviews and editorials are also published. A Methodology forum, which publishes contributions on methodological aspects of diabetes in vivo and in vitro, is also available. The Editor-in-chief will be pleased to consider articles describing new techniques (e.g., new transplantation methods, metabolic models), of innovative importance in the field of diabetes/metabolism. Finally, workshop reports are also welcome in Acta Diabetologica.