Abstract
Background
The objective of the study was to determine whether chronic osteomyelitis (COM) is
associated with increased risk of new-onset atrial fibrillation (AF).
Methods
A national insurance claim data set of 23 million enrollees was used to identify 19,002
patients with newly-diagnosed COM and 76,008 randomly selected age- and sex-matched
control subjects between January 1, 2000 and December 31, 2009 for comparing the risk
and incidence of AF. The study end point was defined as the first diagnosis of AF,
death, withdrawal from the insurance program, or the end of 2010.
Results
During a follow-up period of 91,927 person-years, the incidence of new-onset AF in
COM cohort was 1.42-fold higher than for the non-COM cohort (4.54 vs 3.19 per 1000
person-years). After adjusting for age, sex, and classical AF risk factors such as
hypertension, diabetes, heart failure, coronary artery disease, and valvular heart
disease, the risk of new-onset AF remained significantly higher in the COM cohort
(hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.18-1.49; P < 0.0001). In age-stratified analysis, the younger population carried a higher risk
for incident AF than the elderly population (from HR 2.05; 95% CI, 1.12-3.74 in age
younger than 50 years to HR 1.19; 95% CI, 0.95-1.49 in age 80 years and older). The
adjusted Kaplan-Meier analysis showed a lower AF-free survival rate in the COM group
compared with the control group (log-rank P < 0.0001) during the follow-up period.
Conclusions
This study showed that patients with COM carry an increased risk for developing new-onset
AF, particularly in the younger population. Further studies are required to explore
the underlying mechanisms that link COM and AF.
Résumé
Introduction
L’étude avait pour but de déterminer si l’ostéomyélite chronique (OC) est associée
à un risque accru d’apparition de la fibrillation auriculaire (FA).
Méthodes
Un ensemble national de données portant sur les demandes d’indemnisation de 23 millions
de participants a servi à repérer 19 002 patients ayant récemment reçu un diagnostic
d’OC et 76 008 sujets témoins appariés selon l’âge et le sexe et sélectionnés au hasard
du 1er janvier 2000 au 31 décembre 2009. L’objectif était de comparer le risque de survenue
de la FA et son incidence. La fin de l’étude coïncidait avec un premier diagnostic
de FA, la mort, le retrait du régime d’assurance ou la fin de l’année 2010.
Résultats
Au cours d’une période de suivi équivalant à 91 927 années-personnes, l’incidence
de la FA au sein de la cohorte OC était 1,42 fois plus élevée que dans la cohorte
témoin (4,54 vs 3,19 pour 1000 années-personnes). Après ajustement en fonction de
l’âge, du sexe et des facteurs de risque habituels de la FA tels que l’hypertension,
le diabète, l’insuffisance cardiaque, la coronaropathie et la valvulopathie, le risque
d’apparition de la FA demeurait significativement plus élevé dans la cohorte OC (rapport
de risques instantanés [RRI] : 1,33; intervalle de confiance [IC] à 95 % : 1,18-1,49;
p < 0,0001). Selon une analyse stratifiée en fonction de l’âge, les sujets plus jeunes
présentaient un risque d’apparition de la FA supérieur, comparativement aux sujets
âgés (RRI : 2,05; IC à 95 % : 1,12-3,74 pour les sujets de moins de 50 ans; RRI :
1,19; IC à 95 % : 0,95-1,49 pour les sujets de 80 ans et plus). L’analyse ajustée
de Kaplan-Meier a révélé que le taux de survie sans FA était plus faible dans le groupe
OC que dans le groupe témoin (p [test de Mantel-Haenszel] < 0,0001) durant la période de suivi.
Conclusions
Cette étude a montré que le risque d’apparition de la FA est plus grand chez les patients
atteints d’OC, en particulier chez les plus jeunes. D’autres études devront être menées
pour expliciter les mécanismes sous-jacents liant l’OC et la FA.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Is atrial fibrillation an inflammatory disorder?.Eur Heart J. 2006; 27: 136-149
- Role of inflammation in initiation and perpetuation of atrial fibrillation: a systematic review of the published data.J Am Coll Cardiol. 2007; 50: 2021-2028
- Update on the association of inflammation and atrial fibrillation.J Cardiovasc Electrophysiol. 2010; 21: 1064-1070
- Increased risk of atrial fibrillation in patients with coeliac disease: a nationwide cohort study.Eur Heart J. 2011; 32: 2430-2437
- Psoriasis and risk of atrial fibrillation and ischaemic stroke: a Danish Nationwide Cohort Study.Eur Heart J. 2012; 33: 2054-2064
- Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study.JAMA. 1994; 271: 840-844
- Impact of atrial fibrillation on the risk of death: the Framingham Heart Study.Circulation. 1998; 98: 946-952
- Biomarkers in atrial fibrillation: a clinical review.Eur Heart J. 2013; 34: 1475-1480
- Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation.Chest. 2010; 137: 263-272
- Inflammation as a risk factor for atrial fibrillation.Circulation. 2003; 108: 3006-3010
- Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC).Eur Heart J. 2010; 31: 2369-2429
- New-onset atrial fibrillation during hospitalization.J Am Coll Cardiol. 2014; 64: 2432-2433
- Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis.JAMA. 2011; 306: 2248-2254
- Etiologic diagnosis of chronic osteomyelitis: a prospective study.Arch Intern Med. 2006; 166: 95-100
- Systemic antibiotic therapy for chronic osteomyelitis in adults.Clin Infect Dis. 2012; 54: 393-407
- Increased risk of coronary heart disease in patients with chronic osteomyelitis: a population-based study in a cohort of 23 million.Heart. 2014; 100: 1450-1454
- Increased risk of ischaemic stroke amongst patients with chronic osteomyelitis: a population-based cohort study in Taiwan.Eur J Neurol. 2015; 22: 633-639
- Does universal health insurance make health care unaffordable? Lessons from Taiwan.Health Aff (Millwood). 2003; 22: 77-88
- Validation of the National Health Insurance Research Database with ischemic stroke cases in Taiwan.Pharmacoepidemiol Drug Saf. 2011; 20: 236-242
- Increased risk of first-ever stroke in younger patients with atrial fibrillation not recommended for antithrombotic therapy by current guidelines: a population-based study in an East Asian cohort of 22 million people.Mayo Clin Proc. 2014; 89: 1487-1497
- Accuracy of diabetes diagnosis in health insurance claims data in Taiwan.J Formos Med Assoc. 2005; 104: 157-163
- Compliance with antithrombotic prescribing guidelines for patients with atrial fibrillation–a nationwide descriptive study in Taiwan.Clin Ther. 2008; 30: 1726-1736
- Continuation of statin therapy and a decreased risk of atrial fibrillation/flutter in patients with and without chronic kidney disease.Atherosclerosis. 2014; 232: 224-230
- Using the CHA2DS2-VASc score for refining stroke risk stratification in ‘low-risk’Asian patients with atrial fibrillation.J Am Coll Cardiol. 2014; 64: 1658-1665
- Should atrial fibrillation patients with 1 additional risk factor of the CHA2DS2-VASc score (beyond sex) receive oral anticoagulation?.J Am Coll Cardiol. 2015; 65: 635-642
- New inflammatory predictors for non-valvular atrial fibrillation: echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio.Int J Cardiovasc Imaging. 2014; 30: 81-89
- Inflammation-sensitive proteins and risk of atrial fibrillation: a population-based cohort study.Eur J Epidemiol. 2011; 26: 449-455
- Inflammation in the genesis and perpetuation of atrial fibrillation.Eur Heart J. 2005; 26: 2083-2092
- Role of inflammation and oxidative stress in atrial fibrillation.Heart Rhythm. 2010; 7: 438-444
- Risk of carotid atherosclerosis is associated with low serum paraoxonase (PON1) activity among arsenic exposed residents in Southwestern Taiwan.Toxicol Appl Pharmacol. 2009; 236: 246-253
- Inflammatory pathways underlying atrial fibrillation.Trends Mol Med. 2011; 17: 556-563
- Inflammation and C-reactive protein in atrial fibrillation: cause or effect?.Tex Heart Inst J. 2014; 41: 461-468
- High-sensitivity troponin T as a biomarker for the development of atrial fibrillation after cardiac surgery.Eur J Cardiothorac Surg. 2014; 45: 733-738
- Current concepts in pathogenesis of acute and chronic osteomyelitis.Curr Opin Infect Dis. 2015; 28: 240-245
- Lone atrial fibrillation - an overview.Int J Clin Pract. 2014; 68: 418-433
- ‘Lone’ atrial fibrillation: no longer lone or even alone.Curr Pharm Des. 2015; 21: 531-532
- Alcohol consumption as a risk factor for atrial fibrillation: a systematic review and meta-analysis.Eur J Cardiovasc Prev Rehabil. 2010; 17: 706-712
- The impact of smoking on thromboembolism and mortality in patients with incident atrial fibrillation: insights from the Danish Diet, Cancer, and Health study.Chest. 2014; 145: 559-566
- Effect of active smoking on comparative efficacy of antithrombotic therapy in patients with atrial fibrillation: the Loire Valley Atrial Fibrillation Project.Chest. 2015; 148: 491-498
Article info
Publication history
Published online: April 21, 2016
Accepted:
April 18,
2016
Received:
October 9,
2015
Footnotes
See editorial by Shahid et al., pages 1366–1368 of this issue.
See page 1394 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
