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Atrial fibrillation in the Malmö diet and cancer study: a study of occurrence, risk factors and diagnostic validity

  • Cardiovascular Disease
  • Published:
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Abstract

The validity of atrial fibrillation (AF) diagnoses in national registers for use as endpoints in prospective studies has not been evaluated. We studied the validity of AF diagnoses in Swedish national hospital discharge and cause of death registers and the occurrence of and risk factors for AF in a middle-aged Swedish population using these registers. Our study included the 30,447 individuals (age 44–73) who attended baseline visits in 1991–1996 of the Malmö Diet and Cancer study. Individuals with a first AF diagnosis were identified by record linkage with national registers. A subset of cases was randomly selected for validation by examination of electrocardiograms and patient records. Electrocardiograms were available in 98% of the validation sample (95% definitive AF, 3% no AF). The 2% with ECGs unavailable had probable AF. Baseline AF prevalence was 1.3%, higher in men and increased with age. During 11.2 years of follow-up 1430 first AF diagnoses occurred. Risk factors were age, hypertension, BMI, diabetes, history of heart failure, history of myocardial infarction and, in men but not women, current smoking. The strongest risk factors were history of heart failure (hazard ratio men 4.5, women 8.7) and myocardial infarction (hazard ratio men 2.0, women 1.8). The largest population attributable risks were observed for hypertension (men 38%, women 34%) and obesity (men 11%, women 10%). In conclusion, case misclassification of AF in national registers is small, indicating feasibility of use in prospective studies. Hypertension and obesity account for large portions of population risk in middle-aged individuals with low prevalence of manifest cardiac disease.

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Abbreviations

AF:

Atrial fibrillation

ECG:

Electrocardiogram

PAR:

Population attributable risk

MDCS:

The Malmö Diet and Cancer Study

BMI:

Body mass index

HDR:

The Swedish Hospital Discharge Register

CDR:

The Swedish Cause of Death Register

ICD:

The International Classification of Diseases

HR:

Hazard ratio

95% CI:

95% confidence interval

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Acknowledgments

MDCS was made possible by grants from the Malmö city council. J. Gustav Smith gratefully acknowledges financial support from the Swedish Heart Lung Foundation. Pyotr Platonov was supported by governmental funding for clinical research within the Swedish NHS. Olle Melander was supported by grants from the Swedish Medical Research Council, the Swedish Heart and Lung Foundation, the Medical Faculty of Lund University, Malmö University Hospital, the Albert Påhlsson Research Foundation, the Crafoord foundation, the Ernhold Lundströms Research Foundation, the Region Skane, the Hulda and Conrad Mossfelt Foundation, the King Gustaf V and Queen Victoria Foundation, the Lennart Hanssons Memorial Fund, the Wallenberg Foundation.

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Authors and Affiliations

  1. Department of Clinical Sciences, Lund University, Clinical Research Center (CRC), Malmö University Hospital, Entrance 72, Bldg 91, Floor 12, 205 02, Malmö, Sweden

    J. Gustav Smith, Bo Hedblad, Gunnar Engström & Olle Melander

  2. Department of Clinical Sciences, Lund University, Lund, Sweden

    J. Gustav Smith & Pyotr G. Platonov

  3. Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA

    J. Gustav Smith

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  1. J. Gustav Smith
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  2. Pyotr G. Platonov
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  3. Bo Hedblad
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  4. Gunnar Engström
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  5. Olle Melander
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Correspondence to J. Gustav Smith.

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Smith, J.G., Platonov, P.G., Hedblad, B. et al. Atrial fibrillation in the Malmö diet and cancer study: a study of occurrence, risk factors and diagnostic validity. Eur J Epidemiol 25, 95–102 (2010). https://doi.org/10.1007/s10654-009-9404-1

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  • DOI: https://doi.org/10.1007/s10654-009-9404-1

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