Long-term individual and population functional outcomes in older adults with atrial fibrillation
- 4 March 2021
- journal article
- research article
- Published by Wiley in Journal of the American Geriatrics Society
- Vol. 69 (6), 1570-1578
- https://doi.org/10.1111/jgs.17087
Abstract
Background Older adults with atrial fibrillation (AF) have multiple risk factors for disablement. Long-term function and the contribution of strokes to disability have not been previously characterized. Our objective was to determine long-term function among older adults with AF and the relative contribution of stroke. Methods We used data from the nationally representative Health and Retirement Study (1992-2014) with participants >= 65 years with incident AF. We examined the association of incident stroke with three outcomes: independence with activities of daily living (ADL), instrumental activities of daily living (IADL), and residence outside a nursing home (community-dwelling). We fit logistic regression models with repeated measures adjusting for comorbidities and demographics to estimate the effect of stroke on function. We estimated the contribution of strokes to the overall population burden of disability using the method of recycled predictions. Results Among 3530 participants (median age 79 years, 53% women), 262 had a stroke over 17,396 person-years. Independent of stroke and accounting for comorbidities, annually, ADL independence decreased by 4.4%, IADL independence decreased by 3.9%, and community dwelling decreased by 1.2% (p < 0.05 for all). Accounting for comorbidities, of those who experienced a stroke, 31.9% developed new ADL dependence, 26.5% developed new IADL dependence, and 8.6% newly moved to a nursing home (p < 0.05 for all). Considering all causes of function loss, 1.7% of ADL disability-years, 1.2% of IADL disability-years, and 7.3% of nursing home years could be attributed to stroke over 7.4 years. Conclusion Older adults lose substantial function over time following AF diagnosis, independent of stroke. Stroke was associated with a significant functional decline and increase in the likelihood of nursing home move, but stroke did not accelerate subsequent disability accrual. Because of the high background rate of disability, stroke was not the dominant determinant of population-level disability in older adults with AF.Funding Information
- National Center for Advancing Translational Sciences (KL2TR001870)
- National Heart, Lung, and Blood Institute (K24HL141354)
- National Institute on Aging (P30AG044281, K24AG068312, K24AG049057, sT32‐AG0002)
This publication has 35 references indexed in Scilit:
- Increased risk of cognitive and functional decline in patients with atrial fibrillation: results of the ONTARGET and TRANSCEND studiesCMAJ : Canadian Medical Association Journal, 2012
- Antithrombotic Therapy Use at Discharge and 1 Year in Patients With Atrial Fibrillation and Acute StrokeStroke, 2011
- Geriatric Syndromes: Clinical, Research, and Policy Implications of a Core Geriatric ConceptJournal of the American Geriatrics Society, 2007
- Coding of Stroke and Stroke Risk Factors Using International Classification of Diseases , Revisions 9 and 10Stroke, 2005
- Subclinical Brain Magnetic Resonance Imaging Abnormalities Predict Physical Functional Decline in High‐Functioning Older AdultsJournal of the American Geriatrics Society, 2005
- Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failureJournal of Clinical Epidemiology, 2004
- Stroke Severity in Atrial FibrillationStroke, 1996
- Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysisJournal of Clinical Epidemiology, 1996
- An Overview of the Health and Retirement StudyThe Journal of Human Resources, 1995
- Silent cerebral infarction in chronic atrial fibrillation.Stroke, 1987