Abstract and Introduction
Abstract
Background Atrial fibrillation (AF)–related symptoms and physical performance are relied upon to guide therapeutic management of patients with AF. We sought to understand whether AF predisposes to or is a result of physical disability and poor subjective health in the community.
Methods We studied relations between physical disability (Rosow-Breslau Functional Health Scale), subjective health (self-report) and incident AF, and the converse, in the Framingham Heart Study.
Results In 3,609 participants (age 73 ± 8 years, 59% women), a subset of 861 participants (24%) had prevalent physical disability at baseline. During 5.8 ± 1.8 years of follow-up, 555 participants (10-year age- and sex-adjusted incidence rate 13%) developed incident AF. Prevalent physical disability was related to incident AF (multivariable-adjusted hazard ratio 1.25, 95% CI 1.02–1.54, P = .03). In 3,525 participants, prevalent poor subjective health (n = 333) also was related to incident AF (n = 552, multivariable-adjusted hazard ratio 1.31, 95% CI 1.00–1.70, P = .048). Conversely, in 2,080 participants (age 69 ± 6 years, 55% women), interim AF (n = 106) was associated with newly reported physical disability (n = 573) at a follow-up examination (multivariable-adjusted odds ratio 1.58, 95% CI 1.08–2.31, P = .01). In 1,954 participants, interim AF (n = 96) likewise was related to newly reported poor subjective health (n = 224, multivariable-adjusted odds ratio 1.83, 95% CI 1.10–3.02, P = .02).
Conclusions Physical disability and poor subjective health were related to incident AF in a community-based cohort. Conversely, interim AF was related to newly reported physical disability and poor subjective health. Because AF guidelines incorporate symptoms, it is essential to clarify the temporality and mechanisms linking physical disability, subjective health, and AF.
Introduction
Reducing cardiovascular morbidity and mortality is a principal goal of atrial fibrillation (AF) therapy. Hence, minimizing AF-related symptoms and improving both physical performance and quality of life have become major considerations in individualizing therapy for patients with AF.
The relations between AF and physical disability and poor subjective health are complex and incompletely understood as reviewed elsewhere. Whether AF predisposes to or is a result of impaired physical performance is uncertain. Atrial fibrillation may compromise cardiac output and subsequently lead to physical disability. Physical performance is reduced in a substantial number of people with AF. However, impaired physical performance is not specific for AF. Physical disability may be caused by other conditions, such as musculoskeletal disorders, stroke, cancer, diabetes, heart failure, obesity, or advancing age. Thus, physical disability may represent the burden of underlying conditions, many of which have been identified individually as risk factors for AF. Furthermore, physical disability itself may contribute causally to incident AF.
We hypothesized a reciprocal relation between physical disability and incident AF. Specifically, we postulated that physical disability and poor subjective health are associated with increased risk of incident AF. We further hypothesized that incident AF is associated with increased physical disability and poor subjective health during follow-up.