Cartoon of a hand holding a heart with an electronic heart signal to the left of the heart to symbolize atrial fibrillation
Credit: Mohamed_hassan/ Pixabay

Research led by the University of Pittsburgh suggests that more attention should be paid to people with atrial fibrillation who are younger than 65 years, as they have considerable health issues and a significantly increased risk of dying compared with the general population.

“Common knowledge among cardiologists is that, in people under 65, atrial fibrillation is extremely uncommon and not detrimental. But there really hasn’t been any data to back that up,” said lead author Aditya Bhonsale, a University of Pittsburgh Medical Center cardiac electrophysiologist assistant professor of medicine, in a press statement.

“We’ve been seeing a lot more young patients with atrial fibrillation in recent years and have been interested in understanding the real-world clinical course of these individuals.”

Atrial fibrillation is the most common form of heart rhythm disorder in the U.S. Numbers of people affected by this condition are increasing and are predicted to reach 12.1 million by 2030. Although it is more common to see heart rhythm conditions in individuals over the age of 65 years, increasing numbers of people are being diagnosed with atrial fibrillation at a younger age.

To investigate this further and look at the consequences of having this condition at a younger age, Bhonsale and colleagues carried out a study, published in the journal Circulation: Arrhythmia and Electrophysiology. The study cohort included 67,221 individuals with atrial fibrillation, 17,335 of whom were under the age of 65 years. Of this younger group, 32% were female.

The patients in the under 65 years group had a significant number of cardiovascular risk factors and comorbidities. The average body mass index was 33 kg/m2 (over 30 is considered obese), 16% were current smokers, 55% had high blood pressure, 21% had diabetes, 20% had heart failure, 19% had coronary artery disease, 18% had obstructive sleep apnea, 11% had chronic obstructive pulmonary disease, 6% had experienced a precious stroke and 1.3% had chronic kidney disease.

The group was followed up for an average period of five years and during this time 2084 people in the under 65 years group died. Of these, 6.7% were under 50 years, and 13% were 50–65 years.

Men and women under the age of 65 years with atrial fibrillation had worse survival than people with similar comorbidities but no atrial fibrillation. Survival in mean and women under the age of 50 years was 1.5- and 2.4-fold worse, respectively, than those without atrial fibrillation. Similarly, in the 50–65 years group survival in men and women was a respective 1.3- and 1.7-fold worse than their peers.

People in the under 65 years group also had more visits to hospital such as heart attack, stroke, and heart failure.

“The results of our study suggest that management of  patients  with  atrial  fibrillation  aged  under 65  years  must  be  in  the  context  of  their  individual  cardiovascular  risk  factors  burden  and  lifestyle  modification  with  an  appropriate  focus  on  noncardiac  risk  factors,” write the authors.

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