Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
PLoS Med. 2021 Jun 8;18(6):e1003659. doi: 10.1371/journal.pmed.1003659. eCollection 2021 Jun.
There is a paucity of information about cardiovascular outcomes related to exercise habit change after a new diagnosis of atrial fibrillation (AF). We investigated the association between exercise habits after a new AF diagnosis and ischemic stroke, heart failure (HF), and all-cause death.
This is a nationwide population-based cohort study using data from the Korea National Health Insurance Service. A retrospective analysis was performed for 66,692 patients with newly diagnosed AF between 2010 and 2016 who underwent 2 serial health examinations within 2 years before and after their AF diagnosis. Individuals were divided into 4 categories according to performance of regular exercise, which was investigated by a self-reported questionnaire in each health examination, before and after their AF diagnosis: persistent non-exercisers (30.5%), new exercisers (17.8%), exercise dropouts (17.4%), and exercise maintainers (34.2%). The primary outcomes were incidence of ischemic stroke, HF, and all-cause death. Differences in baseline characteristics among groups were balanced considering demographics, comorbidities, medications, lifestyle behaviors, and income status. The risks of the outcomes were computed by weighted Cox proportional hazards models with inverse probability of treatment weighting (IPTW) during a mean follow-up of 3.4 ± 2.0 years. The new exerciser and exercise maintainer groups were associated with a lower risk of HF compared to the persistent non-exerciser group: the hazard ratios (HRs) (95% CIs) were 0.95 (0.90-0.99) and 0.92 (0.88-0.96), respectively (p < 0.001). Also, performing exercise any time before or after AF diagnosis was associated with a lower risk of mortality compared to persistent non-exercising: the HR (95% CI) was 0.82 (0.73-0.91) for new exercisers, 0.83 (0.74-0.93) for exercise dropouts, and 0.61 (0.55-0.67) for exercise maintainers (p < 0.001). For ischemic stroke, the estimates of HRs were 10%-14% lower in patients of the exercise groups, yet differences were statistically insignificant (p = 0.057). Energy expenditure of 1,000-1,499 MET-min/wk (regular moderate exercise 170-240 min/wk) was consistently associated with a lower risk of each outcome based on a subgroup analysis of the new exerciser group. Study limitations include recall bias introduced due to the nature of the self-reported questionnaire and restricted external generalizability to other ethnic groups.
Initiating or continuing regular exercise after AF diagnosis was associated with lower risks of HF and mortality. The promotion of exercise might reduce the future risk of adverse outcomes in patients with AF.
关于心房颤动（AF）新诊断后运动习惯改变与心血管结局的信息很少。我们调查了新诊断为 AF 后运动习惯与缺血性卒、心力衰竭（HF）和全因死亡之间的关系。
这是一项使用韩国国家健康保险服务数据的全国性基于人群的队列研究。对 2010 年至 2016 年间 66692 例新诊断为 AF 的患者进行回顾性分析，这些患者在 AF 诊断前和诊断后 2 年内接受了 2 次连续健康检查。根据每次健康检查的自我报告问卷，将患者分为 4 类：持续不运动者（30.5%）、新运动者（17.8%）、运动减少者（17.4%）和运动保持者（34.2%）。主要结局是缺血性卒、HF 和全因死亡的发生率。考虑到人口统计学、合并症、药物、生活方式行为和收入状况，在组间平衡了基线特征的差异。在平均 3.4±2.0 年的随访期间，使用逆概率治疗加权（IPTW）加权 Cox 比例风险模型计算结局的风险。与持续不运动者相比，新运动者和运动保持者患 HF 的风险较低：危险比（HR）（95%CI）分别为 0.95（0.90-0.99）和 0.92（0.88-0.96）（p<0.001）。此外，与持续不运动相比，AF 诊断前后任何时间进行运动与死亡率降低相关：新运动者的 HR（95%CI）为 0.82（0.73-0.91），运动减少者为 0.83（0.74-0.93），运动保持者为 0.61（0.55-0.67）（p<0.001）。对于缺血性卒，运动组患者的 HR 估计值降低了 10%-14%，但差异无统计学意义（p=0.057）。根据新运动者组的亚组分析，能量消耗为 1000-1499 MET-min/wk（规律适度运动 170-240 min/wk）与每种结局的风险降低相关。研究局限性包括由于自我报告问卷的性质而产生的回忆偏倚，以及对其他种族群体的外部推广受限。
AF 诊断后开始或继续进行规律运动与 HF 和死亡率降低相关。促进运动可能会降低 AF 患者未来不良结局的风险。
