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Atrial fibrillation (AF) and co-morbidity in elderly. A population based survey of 85 years old subjects.
Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care in Central County. Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala.
Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care in Central County. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
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2011 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 52, no 3, e170-e175 p.Article in journal (Refereed) Published
Abstract [en]

The occurrence of AF increases sharply with age. The aim of this study was to explore and compare prevalent co-morbidity and self-estimated health-related quality of life (HRQoL) in subjects with AF versus subjects with sinus rhythm or pacemaker in 85 years old subjects. We analyzed data from a population of 336 eighty-five years old subjects participating in the Elderly in Linköping Screening Assessment (ELSA-85) study. Medical history was obtained from postal questionnaire, medical records and during medical examination that included a physical examination, cognitive tests, non-fasting venous blood samples and electrocardiographic (ECG) examination. 19% had an ECG showing AF. There were very few significant differences regarding medical history, self-estimated quality of life (QoL), laboratory- and examination findings and use of public health care between the AF group and the non-AF group. The study showed that the population of 85 years old subjects with AF was surprisingly healthy in terms of prevalent co-existing medical conditions, healthcare contacts and overall HRQoL. We conclude that elderly patients with AF do not in general have increased co-morbidity than subjects without AF.

Place, publisher, year, edition, pages
Elsevier , 2011. Vol. 52, no 3, e170-e175 p.
Keyword [en]
Atrial fibrillation; Co-morbidities of elderly; CHADS2 score; Oral anticoagulation; Health-related quality of life
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-67143DOI: 10.1016/j.archger.2010.10.024ISI: 000288989400015OAI: oai:DiVA.org:liu-67143DiVA: diva2:407700
Note

Original Publication: Karin Rådholm, Carl Johan Östgren, Urban Alehagen, Magnus Falk, Eva Wressle, Jan Marcusson and Katarina Nägga, Atrial fibrillation (AF) and co-morbidity in elderly. A population based survey of 85 years old subjects., 2011, Archives of gerontology and geriatrics (Print), (52), 3, e170-e175. http://dx.doi.org/10.1016/j.archger.2010.10.024 Copyright: Elsevier Science B.V., Amsterdam. http://www.elsevier.com/

Available from: 2011-03-31 Created: 2011-03-31 Last updated: 2015-09-11
In thesis
1. Cardiovascular risk factors in elderly: With special emphasis on atrial fibrillation, hypertension and diabetes
Open this publication in new window or tab >>Cardiovascular risk factors in elderly: With special emphasis on atrial fibrillation, hypertension and diabetes
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

The part of the population that belongs to the oldest-old (ages 80 years or older) increases rapidly, worldwide. Cardiovascular disease (CVD) is the leading cause of death and disease burden globally. Multimorbidity is common in old age and stroke, diabetes mellitus (DM) and atrial fibrillation (AF) are strongly associated with age. Cardiovascular risk factors are well studied and documented in younger and middle ages, but not as well in old and frail individuals. Therefore, preventive treatment choices are mostly based on evidence for younger patients. The aim of this thesis was to explore age and other aspects of cardiovascular risk factors; AF, hypertension and DM, in relation to comorbidity, cardiovascular outcome and mortality.

Methods

This thesis was based on four different studies:

  • The ELSA85 study of 85 years old in Linköping, Sweden
  • The international, multicentre, randomised controlled INTERACT2 trial of spontaneous intracranial haemorrhage (ICH), mean age 64 years.
  • The prospective SHADES study of nursing home residents, mean age 85 years.
  • The prospective, national SWE-diadep study of dispensed antidiabetics, antidepressantsand prevalent myocardial infarction (MI) in 45-84 years old.

Data was obtained from questionnaires (ELSA85, INTERACT2), medical records and medical examination (ELSA85, INTERACT2, SHADES), and national registers (SWE-Diadep).

Results

The ELSA85 study showed that 16% (n=53) had an ECG showing AF. There was an increased hazard ratio (HR) for all-cause mortality in participants with AF at baseline, at 90 years of age (HR 1.59, 95% [Confidence Interval] CI 1.04-2.44) adjusted for sex. This increase in HR did not persist when adjusted for congestive heart failure (CHF). In the INTERACT2 study, increasing age was associated with increasing frequency of death or dependency (odds ratio [OR] 4.36, 95% [CI] 3.12-6.08 for >75 years vs <52 years, p value for trend <0.001). The SHADES study showed that participants with Systolic blood pressure (SBP) <120 mmHg had an increased HR for mortality (1.56, 95% CI, 1.08–2.27; p=0.019) but there were no differences between SBP groups 140–159 mmHg and ≥160 mmHg compared with the reference group SBP 120–139 mmHg. SBP decreased during the prospective study period. In the SWE-diadep study, individuals with antidiabetics and antidepressants combined had a greater HR for MI compared to the reference of no antidiabetics or antidepressants, mostly so in women aged 45-64 years (HR 7.4, 95% CI: 6.3-8.6).

Conclusion

Risk factors for CVDs in elderly differ from cardiovascular risk factors in middle aged individuals an

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 78 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1466
National Category
Public Health, Global Health, Social Medicine and Epidemiology Other Health Sciences Family Medicine
Identifiers
urn:nbn:se:liu:diva-121286 (URN)10.3384/diss.diva-121286 (DOI)978-91-7519-030-3 (print) (ISBN)
Public defence
2015-10-09, Belladonna, ingång 78, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-09-11 Created: 2015-09-11 Last updated: 2015-09-18Bibliographically approved

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Rådholm, KarinÖstgren, Carl JohanAlehagen, UrbanFalk, MagnusWressle, EvaMarcusson, JanNägga, Katarina
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Primary Health Care in Central CountyGeneral PracticeFaculty of Health SciencesPrimary Health Care in MotalaCardiologyDepartment of Cardiology in LinköpingResearch & Development Unit in Local Health CareGeriatricDepartment of Geriatric Medicine in Linköping
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