한빛사논문
- 조회614
Hyo-Jeong Ahn1☯, So-Ryoung Lee1☯, Eue-Keun Choi1,2*, Kyung-Do Han3, JinHyung Jung4, Jae-Hyun Lim1, Jun-Pil Yun1, Soonil Kwon1, Seil Oh1,2, Gregory Y. H. Lip2,5,6
1Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea, 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea, 3Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea, 4Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea, 5Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom, 6Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
☯These authors contributed equally to this work.
*Corresponding author.
Abstract
Background
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.
Methods and findings
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.
Conclusions
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.
논문정보
- Research article
- 2021년 06월 (BRIC 등록일 2021-06-11)
- 국내(교신)+국외 연구진
- 의약학 > 응용의학
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