AFib may affect a lot more younger people than previously thought

Atrial fibrillation (AFib) is a heart rhythm that affects the heart’s upper chambers. Nikhil Warrier, MD, board-certified cardiac electrophysiologist and medical director of electrophysiology at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, who was not involved in the study, explained to Medical News Today:

“AFib or atrial fibrillation is the most common heart rhythm disorder that we manage. It happens when your heart’s upper chamber or atria quiver or beat irregularly or excessively, sometimes in excess of 300-400 beats per minute. The disorganized beating of the heart can put patients at risk for stroke and heart failure.”

Researchers of the current study note that AFib is more likely to occur in adults ages 70-80 and older. However, they also note there is an increasing number of people under age 65 with AFib. Researchers wanted to understand more about the potential dangers associated with AFib in this younger population.

The researchers included 67,221 adults with AFib as part of their study. Of this number, 17,335 participants were under age 65. Researchers looked at all-cause mortality, hospitalizations, and other cardiac interventions that participants received. The average follow-up time with participants was over five years. During the follow-up, 2,084 participants died.

Increased risk of hospitalization from heart problems

The researchers found that participants under age 65 had notable additional cardiovascular risk factors. For example, 16% were current smokers, 55% had high blood pressure, 20% had heart failure, 21% had diabetes, and over 20% had significant obesity. Over half of the participants under age 65 were receiving anticoagulants.

Overall, researchers also found that participants under 65 years of age with AFib had an increased mortality risk compared to an internal control population and an increased risk for hospitalization from heart attack, heart failure, and all-cause stroke.

Study author Aditya Bhonsale, MD, MHS, assistant professor of medicine with the Division of Cardiac Electrophysiology at UPMC Heart and Vascular Institute, Pittsburgh, PA, explained to Medical News Today:

“Our large real-world cohort demonstrates that AFib patients [younger than] 65 years of age have substantial comorbidity burden, particularly, obesity, heart failure, and hypertension with considerable long-term mortality (6.7% <50 years; 13% 50-65 years). They are also at a significantly increased risk of hospitalization for heart failure, stroke, and myocardial infarction compared to those without AFib.”

“The results of our study suggest that management of AFib patients under 65 years of age must be in the context of their individual CV risk factors burden, lifestyle modification with appropriate focus on non-cardiac risk factors,” Bhonsale added.

This research does have limitations. First, this study cannot establish cause.

Second, 95% of the participants were white, so researchers can include more diverse cohorts in the future. In the population less than fifty years old, 73% of participants were male, so more research could potentially focus on females with AFib in the future.

The researchers acknowledge that they did not measure quality of life metrics or ascertain the cause of death among participants. The researchers also lacked information on alcohol consumption, which could have affected existing relationships.

Bhonsale noted that “Research on impact of risk factor modification and trajectories of risk factors in younger patients needs [to be] done in the future. This will allow for optimal management and mitigate adverse outcomes.”

Managing and preventing AFib are critical, no matter a person’s age. This can include making lifestyle changes to decrease risk and seeking evaluation for AFib so that doctors can intervene early.

For example, consuming alcohol, using illegal drugs, smoking, and being overweight can all increase the risk for AFib. People can make changes like exercising regularly, quitting smoking, and limiting alcohol intake to help decrease their chances of developing AFib.

Cheng-Han Chen, MD, board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, who was not involved in the study, said:

“These findings highlight the need to manage and treat the cardiovascular risk factors in our younger atrial fibrillation patients, in order to potentially improve their longer-term outcomes.”

“Some of the risk factors for atrial fibrillation, such as being older and their family history, are outside someone’s control. However, there are many risk factors that people can work on to decrease their chance of developing atrial fibrillation. These include high blood pressure, obesity, diabetes, smoking, and alcohol use,” Chen added.

The study implies the importance of managing comorbidities to help improve cardiovascular outcomes among younger people with AFib. So, even in people who already have AFib, managing comorbidities and risk factors may still be highly valuable.

“Age, structural heart disease (prior MI, heart failure or valvular heart disease), hypertension, obesity, excessive caffeine/alcohol intake, stress from lifestyle/surgeries/infection, thyroid disease, sleep apnea are some of the risk factors for the development of AFib. Focusing on identifying and modifying any of these risk factors can lead to decreased risk of development of AFib. They are also a core pillar in our treatment of AFib in patients who already have AFib. Simple strategies like a Mediterranean or whole foods/plant-based diet, regular mild to moderate exercise can be effective starting points.”
— Nikhil Warrier, MD