Patients with both atrial fibrillation and diabetes less likely to notice an irregular heartbeat

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Adults with type 1 or type 2 diabetes and atrial fibrillation (AF) are less likely to notice irregular heartbeat symptoms, more likely to have a lower quality of life (QoL), and experience more co-existing health conditions than people with AF, without type 1 or type 2 diabetes. These findings are according to research published this week in the Swiss-AF (Swiss Atrial Fibrillation) study, in the Journal of the American Heart Association (JAHA).  

“Since diabetes is a major risk factor for AF, Tobias Reichlin (professor of cardiology at Bern University Hospital at the University of Bern in Bern, Switzerland) and colleagues investigated differences in patients with and without diabetes regarding AF symptoms and complications. “This research can provide insights on improving the management of AF and prevention of complications”, said Reichlin.  

The study enrolled 2,411 patients diagnosed with AF who were enrolled across 14 healthcare centres in Switzerland (2014 to 2017). The average participant age was approximately 74 years and consisted of 27% women.  

Prior to enrolment, all participants received a clinical examination, blood sampling, cognitive assessment, QoL assessment, and five-minute resting ECG (electrocardiogram). According to patient medical records, approximately 17% of the study participants were diagnosed diabetics. Furthermore, patients were categorised as having either insulin-dependent diabetes or non-insulin-dependent diabetes. Patients taking diabetes medications were not classified by the US standards of type 1 or type 2 diabetes. 

To determine how diabetes may affect AF patients, researchers compared AF symptoms, QoL outcomes, cardiac comorbidities, and neurological comorbidities. Compared to people with AF who did not have diabetes: 

  • Diabetic patients were 25% less likely than those without diabetes to recognise common AF symptoms  
  • People with diabetes were three times more likely than those without diabetes to have high blood pressure; 55% more likely to have had heart attacks, and twice as likely to have heart failure 
  • People with diabetes had a 39% increased stroke risk and were 75% more likely to have cognitive impairment 

“The reduced perception of AF symptoms may result in a delayed diagnosis of AF, and, consequently, more complications such as stroke. Our findings raise the question if patients with diabetes should be routinely screened for AF” said Reichlin.  

 These results were seen even though people with diabetes and AF had more co-existing health conditions such as high blood pressure, as well as a medical history of heart attack and heart failure. Considering these observations, and the serious consequences of failing to recognise AF in time, it seems prudent to consider screening older patients with diabetes for AF so that treatment may be initiated when appropriate” said Deedwania. Furthermore, the study elucidated that having both diabetes and AF, negatively impacted mobility, self-care, and normal activities compared to people without diabetes. 

The researchers note several potential limitations to this Swiss-AF study. The diagnosis of diabetes was based on the medical history of the study’s participants rather than laboratory criteria; therefore, the prevalence of diabetes may have been underreported. Data were not available on the duration of diabetes or the degree of glycemic control. Additionally, the study included only residents of Switzerland, therefore, the generalisability of the findings to other geographical populations requires further investigation. Future studies among larger, more diverse populations are needed to confirm the findings of the study.  


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