Trends in excess mortality associated with atrial fibrillation over 45 years (Framingham Heart Study): community based cohort study.

To assess temporal trends in the association between newly diagnosed atrial fibrillation and death. Community based cohort study. Framingham Heart Study cohort, in 1972-85, 1986-2000, and 2001-15 (periods 1-3, respectively), in Framingham, MA, USA. Participants with no atrial fibrillation, aged 45-95 in each time period, and identified with newly diagnosed atrial fibrillation (or atrial flutter) during each time period. The main outcome was all cause mortality. Hazard ratios for the association between time varying atrial fibrillation and all cause mortality were calculated with adjustment for time varying confounding factors. The difference in restricted mean survival times, adjusted for confounders, between participants with atrial fibrillation and matched referents at 10 years after a diagnosis of atrial fibrillation was estimated. Meta-regression was used to test for linear trends in hazard ratios and restricted mean survival times over the different time periods. 5671 participants were selected in time period 1, 6177 in period 2, and 6174 in period 3. Adjusted hazard ratios for all cause mortality between participants with and without atrial fibrillation were 1.9 (95% confidence interval 1.7 to 2.2) in time period 1, 1.4 (1.3 to 1.6) in period 2, and 1.7 (1.5 to 2.0) in period 3 (P No evidence of a temporal trend in hazard ratios for the association between atrial fibrillation and all cause mortality was found. The mean number of life years lost to atrial fibrillation at 10 years had improved significantly, but a two year gap compared with individuals without atrial fibrillation still remained.

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Déclaration de conflit d'intérêts

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from National Institutes of Health/National Heart, Lung, and Blood Institute (NIH/NHLBI), Framingham Heart Study, and the Boston University School of Medicine for the submitted work; LF reports grants from the Health Research Foundation of Central Denmark Region, personal fees from Bristol-Myers Squibb, personal fees from Pfizer, personal fees from Bayer, and personal fees from Merck Sharp and Dohme, outside of the submitted work. EJB serves as an uncompensated member of the MyHeartLab Steering Committee. The MyHeartLab Study is a principal investigator initiated study from the University of California San Francisco (UCSF): principal investigator Jeffrey Olgin, through a research grant to UCSF from Samsung. NV, QH, MF-G, and LT have no competing interests.