Impact of Atrial Fibrillation on the Risk of Death: The Framingham Heart Study
Abstract
Background —Atrial fibrillation (AF) causes substantial morbidity. It is uncertain whether AF is associated with excess mortality independent of associated cardiac conditions and risk factors. Methods and Results —We examined the mortality of subjects 55 to 94 years of age who developed AF during 40 years of follow-up of the original Framingham Heart Study cohort. Of the original 5209 subjects, 296 men and 325 women (mean ages, 74 and 76 years, respectively) developed AF and met eligibility criteria. By pooled logistic regression, after adjustment for age, hypertension, smoking, diabetes, left ventricular hypertrophy, myocardial infarction, congestive heart failure, valvular heart disease, and stroke or transient ischemic attack, AF was associated with an OR for death of 1.5 (95% CI, 1.2 to 1.8) in men and 1.9 (95% CI, 1.5 to 2.2) in women. The risk of mortality conferred by AF did not significantly vary by age. However, there was a significant AF-sex interaction: AF diminished the female advantage in survival. In secondary multivariate analyses, in subjects free of valvular heart disease and preexisting cardiovascular disease, AF remained significantly associated with excess mortality, with about a doubling of mortality in both sexes. Conclusions —In subjects from the original cohort of the Framingham Heart Study, AF was associated with a 1.5- to 1.9-fold mortality risk after adjustment for the preexisting cardiovascular conditions with which AF was related. The decreased survival seen with AF was present in men and women and across a wide range of ages.
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In adjusted models, atrial fibrillation is associated with increased morbidity, especially stroke and heart failure, as well as increased mortality.
“In adjusted models, AF is associated with increased morbidity, especially stroke and heart failure, as well as increased mortality.2–5”
From Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study (2014) · cites this paper as [3]
In North American and European populations, the age-adjusted incidence of AF is 1.5 to 2 times higher in men than in women.
“In North American and European populations, the age-adjusted incidence of AF has been estimated to be 1.5 to 2 times higher in men than in women (Supplementary Tables S1 and S2).”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [15]
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- Authors
- Benjamin, E. J., Wolf, P. A., D’Agostino, R. B., Silbershatz, H., Kannel, W. B., & Levy, D.
- Affiliations
- Boston University (US)
- Venue
- Circulation
- Published
- 1998-09-08
- Volume
- 98
- Issue
- 10
- Pages
- 946-952
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2151074096
- Cited by
- 4,575
- References
- 37
- Citations by year
- 2026: 76 · 2025: 123 · 2024: 146 · 2023: 149 · 2022: 189 · 2021: 242 · 2020: 225 · 2019: 206 · 2018: 215 · 2017: 237 · 2016: 238 · 2015: 232 · 2014: 230 · 2013: 279 · 2012: 237
- FWCI
- 35.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc038038-022, 2r01ns017590-07a1)
- National Heart, Lung, and Blood Institute (N01-HC-38038)
- National Institute of Neurological Disorders and Stroke (5-R01-NS-17590-16)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial fibrillation, mortality risk, sex differences in survival, Framingham Heart Study, older adults, cardiovascular disease, valvular heart disease, congestive heart failure, left ventricular hypertrophy
- MeSH terms
- Adult, Age Factors, Aged, Aged, 80 and over, Atrial Fibrillation, Blood Pressure, Ischemic Attack, Transient, Cerebrovascular Disorders, Diabetes Mellitus, Female, Follow-Up Studies, Heart Failure, Heart Valve Diseases, Humans, Hypertension, Male, Massachusetts, Middle Aged, Myocardial Infarction, Regression Analysis, Risk Factors, Sex Factors, Smoking, Time Factors, Cohort Studies
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