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Original article
Gout and the risk of incident atrial fibrillation in older adults: a study of US Medicare data
  1. Jasvinder A Singh1,2,3 and
  2. John D Cleveland2
  1. 1 Medicine Service, VA Medical Center, Birmingham, Alabama, USA
  2. 2 Department of Medicine at School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
  3. 3 Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr Jasvinder A Singh; jasvinder.md{at}gmail.com

Abstract

Objective To assess the association of gout with new-onset atrial fibrillation (AF) in the elderly.

Methods We used the 5% Medicare data from 2005 to 2012 to assess whether a diagnosis of gout was associated with incident AF. We used multivariable Cox regression adjusted for demographics, Charlson-Romano comorbidity index, common cardiovascular medications, allopurinol and febuxostat use, to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results Among 1 647 812 eligible people, 9.8% had incident AF. The mean age was 75 years, 42% were male, 86% were white and the mean Charlson-Romano index score was 1.52. We noted 10 604 incident AF cases in people with gout and 150 486 incident AF cases in people without gout. The crude incidence rates of AF in people with and without gout were 43.4 vs 16.3 per 1000 patient-years, respectively. After multivariable-adjustment, gout was associated with a higher HR of incident AF, 1.92 (95% CI 1.88 to 1.96), with minimal attenuation of HR in sensitivity models that replaced the Charlson-Romano index score with a categorical variable, HR was 1.91 (95% CI 1.87 to 1.95). In another model that adjusted for AF-specific risk factors including hypertension, hyperlipidaemia and coronary artery disease and individual Charlson-Romano index comorbidities, the HR was slightly attenuated at 1.71 (95% CI 1.67 to 1.75). Older age, male sex, white race and higher Charlson-Romano index score were each associated with higher hazard of incident AF.

Conclusion A diagnosis of gout almost doubled the risk of incident AF in the elderly. Future studies should explore the pathogenesis of this association.

  • Gout
  • Atrial fibrillation
  • Epidemiology
  • Risk factor
  • Older adults

This is an Open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors JAS designed the study, developed study protocol, reviewed analyses and wrote the first draft of the paper. JDC performed the data abstraction and data analyses. All authors revised the manuscript, read and approved the final manuscript.

  • Funding This material is the result of work supported by research funds from the Division of Rheumatology at the University of Alabama at Birmingham and the resources and use of facilities at the Birmingham VA Medical Center, Birmingham, Alabama, USA.

  • Disclaimer The funding body did not play any role in design, in the collection, analysis and interpretation of data; in the writing of the manuscript and in the decision to submit the manuscript for publication.

  • Competing interests JAS has received research grants from Takeda and Savient and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta/Horizon and Allergan pharmaceuticals, WebMD, UBM LLC and the American College of Rheumatology. JAS serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA, Inc., a 501 (c)(3) entity. JAS is a member of the executive of OMERACT, an organisation that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee (AMPC); Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee and a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Planning Committee (AMPC); Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee and a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis.

  • Patient consent Not required.

  • Ethics approval The University of Alabama at Birmingham’s Institutional Review Board approved this study and all investigations were conducted in conformity with ethical principles of research. The IRB waived the need for informed consent for this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement These data can be obtained from the Centers for Medicare and Medicaid Services (CMS) Chronic Condition Data Warehouse. We are ready to share the data with colleagues, after obtaining appropriate permissions from the Centers for Medicare and Medicaid Services (CMS) Chronic Condition Data Warehouse and the University of Alabama at Birmingham (UAB) Ethics Committee, related to HIPAA and Privacy policies.

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