Incident atrial fibrillation and the risk of fracture in the cardiovascular health study

E. R. Wallace, D. S. Siscovick, C. M. Sitlani, S. Dublin, P. Mitchell, J. A. Robbins, H. A. Fink, J. A. Cauley, P. Bůžková, Laura D Carbone, Z. Chen, S. R. Heckbert

Research output: Contribution to journalArticle

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Abstract

Summary: In this prospective cohort of 4462 older adults, incident atrial fibrillation (AF) was not statistically significantly associated with subsequent risk of incident fracture. Introduction: AF is associated with stroke, heart failure, dementia, and death, but its association with fracture is unknown. Therefore, we examined the association of incident AF with the risk of subsequent fracture in the Cardiovascular Health Study (CHS) cohort. Methods: Of the CHS participants aged ≥65 years, 4462 were followed between 1991 and 2009, mean follow-up 8.8 years. Incident AF was identified by annual study electrocardiogram (ECG), hospital discharge diagnosis codes, or Medicare claims. Fractures of the hip, distal forearm, humerus, or pelvis were identified using hospital discharge diagnosis codes or Medicare claims. We used Cox proportional hazard models to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for the association between incident AF (time-varying) and the risk of subsequent fracture. We also evaluated whether AF was associated with risk of sustaining a fall. Results: Crude incident fracture rate was 22.9 per 1000 person-years in participants with AF and 17.7 per 1000 person-years in participants without AF. Individuals with incident AF were not at significantly higher risk of hip fracture (adjusted HR = 1.09, 95 % CI 0.83–1.42) or fracture at any selected site (adjusted HR = 0.97, 95 % CI 0.77–1.22) or risk of sustaining a fall (adjusted HR = 1.00, 95 % CI = 0.87–1.16) compared with those without AF. Conclusion: In this cohort of older, community-dwelling adults, incident AF was not shown to be associated with falls or hip or other fractures.

Original languageEnglish (US)
Pages (from-to)719-725
Number of pages7
JournalOsteoporosis International
Volume28
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Atrial Fibrillation
Health
Confidence Intervals
Hip Fractures
Medicare
Independent Living
Humerus
Pelvis
Proportional Hazards Models
Forearm
Dementia
Hip
Electrocardiography
Cohort Studies
Heart Failure
Stroke

Keywords

  • Arrhythmia
  • Atrial fibrillation
  • Fracture
  • Hip fracture

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

Wallace, E. R., Siscovick, D. S., Sitlani, C. M., Dublin, S., Mitchell, P., Robbins, J. A., ... Heckbert, S. R. (2017). Incident atrial fibrillation and the risk of fracture in the cardiovascular health study. Osteoporosis International, 28(2), 719-725. https://doi.org/10.1007/s00198-016-3778-1

Incident atrial fibrillation and the risk of fracture in the cardiovascular health study. / Wallace, E. R.; Siscovick, D. S.; Sitlani, C. M.; Dublin, S.; Mitchell, P.; Robbins, J. A.; Fink, H. A.; Cauley, J. A.; Bůžková, P.; Carbone, Laura D; Chen, Z.; Heckbert, S. R.

In: Osteoporosis International, Vol. 28, No. 2, 01.02.2017, p. 719-725.

Research output: Contribution to journalArticle

Wallace, ER, Siscovick, DS, Sitlani, CM, Dublin, S, Mitchell, P, Robbins, JA, Fink, HA, Cauley, JA, Bůžková, P, Carbone, LD, Chen, Z & Heckbert, SR 2017, 'Incident atrial fibrillation and the risk of fracture in the cardiovascular health study', Osteoporosis International, vol. 28, no. 2, pp. 719-725. https://doi.org/10.1007/s00198-016-3778-1
Wallace ER, Siscovick DS, Sitlani CM, Dublin S, Mitchell P, Robbins JA et al. Incident atrial fibrillation and the risk of fracture in the cardiovascular health study. Osteoporosis International. 2017 Feb 1;28(2):719-725. https://doi.org/10.1007/s00198-016-3778-1
Wallace, E. R. ; Siscovick, D. S. ; Sitlani, C. M. ; Dublin, S. ; Mitchell, P. ; Robbins, J. A. ; Fink, H. A. ; Cauley, J. A. ; Bůžková, P. ; Carbone, Laura D ; Chen, Z. ; Heckbert, S. R. / Incident atrial fibrillation and the risk of fracture in the cardiovascular health study. In: Osteoporosis International. 2017 ; Vol. 28, No. 2. pp. 719-725.
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abstract = "Summary: In this prospective cohort of 4462 older adults, incident atrial fibrillation (AF) was not statistically significantly associated with subsequent risk of incident fracture. Introduction: AF is associated with stroke, heart failure, dementia, and death, but its association with fracture is unknown. Therefore, we examined the association of incident AF with the risk of subsequent fracture in the Cardiovascular Health Study (CHS) cohort. Methods: Of the CHS participants aged ≥65 years, 4462 were followed between 1991 and 2009, mean follow-up 8.8 years. Incident AF was identified by annual study electrocardiogram (ECG), hospital discharge diagnosis codes, or Medicare claims. Fractures of the hip, distal forearm, humerus, or pelvis were identified using hospital discharge diagnosis codes or Medicare claims. We used Cox proportional hazard models to estimate hazard ratios (HRs) and 95 {\%} confidence intervals (CIs) for the association between incident AF (time-varying) and the risk of subsequent fracture. We also evaluated whether AF was associated with risk of sustaining a fall. Results: Crude incident fracture rate was 22.9 per 1000 person-years in participants with AF and 17.7 per 1000 person-years in participants without AF. Individuals with incident AF were not at significantly higher risk of hip fracture (adjusted HR = 1.09, 95 {\%} CI 0.83–1.42) or fracture at any selected site (adjusted HR = 0.97, 95 {\%} CI 0.77–1.22) or risk of sustaining a fall (adjusted HR = 1.00, 95 {\%} CI = 0.87–1.16) compared with those without AF. Conclusion: In this cohort of older, community-dwelling adults, incident AF was not shown to be associated with falls or hip or other fractures.",
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AU - Wallace, E. R.

AU - Siscovick, D. S.

AU - Sitlani, C. M.

AU - Dublin, S.

AU - Mitchell, P.

AU - Robbins, J. A.

AU - Fink, H. A.

AU - Cauley, J. A.

AU - Bůžková, P.

AU - Carbone, Laura D

AU - Chen, Z.

AU - Heckbert, S. R.

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N2 - Summary: In this prospective cohort of 4462 older adults, incident atrial fibrillation (AF) was not statistically significantly associated with subsequent risk of incident fracture. Introduction: AF is associated with stroke, heart failure, dementia, and death, but its association with fracture is unknown. Therefore, we examined the association of incident AF with the risk of subsequent fracture in the Cardiovascular Health Study (CHS) cohort. Methods: Of the CHS participants aged ≥65 years, 4462 were followed between 1991 and 2009, mean follow-up 8.8 years. Incident AF was identified by annual study electrocardiogram (ECG), hospital discharge diagnosis codes, or Medicare claims. Fractures of the hip, distal forearm, humerus, or pelvis were identified using hospital discharge diagnosis codes or Medicare claims. We used Cox proportional hazard models to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for the association between incident AF (time-varying) and the risk of subsequent fracture. We also evaluated whether AF was associated with risk of sustaining a fall. Results: Crude incident fracture rate was 22.9 per 1000 person-years in participants with AF and 17.7 per 1000 person-years in participants without AF. Individuals with incident AF were not at significantly higher risk of hip fracture (adjusted HR = 1.09, 95 % CI 0.83–1.42) or fracture at any selected site (adjusted HR = 0.97, 95 % CI 0.77–1.22) or risk of sustaining a fall (adjusted HR = 1.00, 95 % CI = 0.87–1.16) compared with those without AF. Conclusion: In this cohort of older, community-dwelling adults, incident AF was not shown to be associated with falls or hip or other fractures.

AB - Summary: In this prospective cohort of 4462 older adults, incident atrial fibrillation (AF) was not statistically significantly associated with subsequent risk of incident fracture. Introduction: AF is associated with stroke, heart failure, dementia, and death, but its association with fracture is unknown. Therefore, we examined the association of incident AF with the risk of subsequent fracture in the Cardiovascular Health Study (CHS) cohort. Methods: Of the CHS participants aged ≥65 years, 4462 were followed between 1991 and 2009, mean follow-up 8.8 years. Incident AF was identified by annual study electrocardiogram (ECG), hospital discharge diagnosis codes, or Medicare claims. Fractures of the hip, distal forearm, humerus, or pelvis were identified using hospital discharge diagnosis codes or Medicare claims. We used Cox proportional hazard models to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for the association between incident AF (time-varying) and the risk of subsequent fracture. We also evaluated whether AF was associated with risk of sustaining a fall. Results: Crude incident fracture rate was 22.9 per 1000 person-years in participants with AF and 17.7 per 1000 person-years in participants without AF. Individuals with incident AF were not at significantly higher risk of hip fracture (adjusted HR = 1.09, 95 % CI 0.83–1.42) or fracture at any selected site (adjusted HR = 0.97, 95 % CI 0.77–1.22) or risk of sustaining a fall (adjusted HR = 1.00, 95 % CI = 0.87–1.16) compared with those without AF. Conclusion: In this cohort of older, community-dwelling adults, incident AF was not shown to be associated with falls or hip or other fractures.

KW - Arrhythmia

KW - Atrial fibrillation

KW - Fracture

KW - Hip fracture

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