Older AFib Patients with Diabetes and Osteoarthritis at Higher Risk of Cardiovascular Diseases

A new study shows that among older adults with non-valvular atrial fibrillation (NVAF), those with diabetes mellitus (DM) and osteoarthritis (OA) incur a higher risk of heart failure (HF) and other cardiovascular diseases (CVDs). The findings were published in BMC Public Health.

In this retrospective observational cohort study, researchers examined data of Hawaii Medicare inpatient, outpatient, and carrier claim files and beneficiary summary files from  2009–2017.

Overall, 19,588 patients were included in analysis; the population were divided into four mutually exclusive cohorts of DM/OA status: with both DM and OA (n=1,230), with DM only (n=4,659), with OA only (n=1,978), or without DM and OA (n=11,721), based on their diagnoses before baseline.

Among the population, patients with cardiovascular diseases (CVDs) were identified (stroke: diabetes n=837, osteoarthritis n=315, diabetes and osteoarthritis n=184, without diabetes and osteoarthritis n=1630)(AMI: diabetes n=438, osteoarthritis = 128, diabetes and osteoarthritis = 118, without diabetes and osteoarthritis n=603)(HF: diabetes n=2,254, osteoarthritis n=764, diabetes and osteoarthritis n=581, without diabetes and osteoarthritis n=4,272).

According to the results, after adjusting for age, sex, race/ethnicity, and other confounders, patients with both DM and OA had a higher risk for HF (HR=1.21 95% CI, 1.10–1.33) than those without DM and OA. Patients with both diseases also had a higher risk of HF than those with just OA. Those with diabetes had higher risks for all three cardiovascular diseases than the other three groups.

Limitations and Conclusions

The study did have its limitations; one being that the severity of the CVDs and types of diabetes were not taken into account. Moreover, the CVD risks were analyzed without adjusting for biomarkers and other potential risk factors such as smoking and physical inactivity. Also, while diseases were identified from large data sets of patients with Medicare Part A & B, Part C claims were not included, thus, some misidentifications could exist, the researchers noted.

The researchers wrote that despite these limitations, “the current study has several strengths. The use of a nine-year longitudinal dataset allowed more accurate CVD risk estimation compared with studies with cross-sectional data. Our data included a high proportion of non-White individuals, which also allowed the risk estimations for those minority groups that have been often overlooked in the past. Additionally, the use of Hawaii Medicare data enabled us to compare the variations in hazard ratios by DM/OA status based on all non-Health Maintenance Organization Medicare beneficiaries aged 65 years or older with NVAF in Hawaii.”

They added that “the finding that older diabetic patients with NVAF would have additional risks for the CVDs will provide a new and useful public health perspective. Healthcare professionals may need to consider developing multifactorial interventions for older adults with NVAF tailored to different DM/OA statuses.”