Long-term risk of atrial fibrillation after the death of a partner

Abstract

Objectives: Severe psychological stress is generally associated with an increased risk of acute cardiovascular diseases, such as myocardial infarction, but it remains unknown whether it also applies to atrial fibrillation. We conducted a population-based case-control study using nationwide Danish health registers to examine the risk of atrial fibrillation after the death of a partner.

Methods: From 1995 through 2014, we identified 88 612 cases with a hospital diagnosis of atrial fibrillation and 886 120 age-matched and sex-matched controls based on risk-set sampling. The conditional logistic regression model was used to calculate adjusted ORs of atrial fibrillation with 95% CIs.

Results: Partner bereavement was experienced by 17 478 cases and 168 940 controls and was associated with a transiently higher risk of atrial fibrillation; the risk was highest 8-14 days after the loss (1.90; 95% CI 1.34 to 2.69), after which it gradually declined. One year after the loss, the risk was almost the same as in the non-bereaved population. Overall, the OR of atrial fibrillation within 30 days after bereavement was 1.41 (95% CI 1.17 to 1.70), but it tended to be higher in persons below the age of 60 years (2.34; 95% CI 1.02 to 5.40) and in persons whose partner had a low predicted mortality 1 month before the death, that is, ≤5 points on the age-adjusted Charlson Comorbidity Index (1.57; 95% CI 1.13 to 2.17).

Conclusions: The severely stressful life event of losing a partner was followed by a transiently increased risk of atrial fibrillation lasting for 1 year, especially for the least predicted losses.

Figure 1

Adjusted ORs of AF according to time since bereavement versus non-bereaved in a population from Denmark between 1995 and 2014. * *ORs are adjusted for age, sex and hospital diagnosis for hypertension, ischaemic heart disease, cardiomyopathy, congestive heart failure, hyperthyroidism, diabetes and cardiovascular medication (vitamin K antagonists MB01AA, ACE inhibitors and angiotensin II antagonists MC09, β-blocking agents MC07, lipid-modifying agents MC10, calcium antagonists MC08D, diuretics MC03, nitrates MC01DA, digoxin MC01, antiplatelet agents MB01AC). †Point estimates are given with error bars representing 95% CIs. AF, atrial fibrillation.

Figure 2

Adjusted ORs of AF within 30 days after bereavement with specific characteristics versus non-bereaved with the same characteristics. * *The vertical dashed line represents the overall OR for AF within 30 days after bereavement compared with non-bereaved. The ORs (except for CVD and diabetes mellitus (DM)) are adjusted for age, sex and hospital diagnosis for hypertension, ischaemic heart disease, cardiomyopathy, congestive heart failure, hyperthyroidism, diabetes and cardiovascular medication (vitamin K antagonists MB01AA, ACE inhibitors and angiotensin II antagonists MC09, β-blocking agents MC07, lipid-modifying agents MC10, calcium antagonists MC08D, diuretics MC03, nitrates MC01DA, digoxin MC01, antiplatelet agents MB01AC). †Point estimates are given with error bars representing 95% CIs. §Cardiovascular disease: hypertension, ischaemic heart disease, cardiomyopathy, congestive heart failure. ¶DM: according to an algorithm developed on the basis of the Danish National Diabetes Register. ‡Risk of death in partner: corresponding ACCI scores 1 month before index day divided into three categories for statistical comparison. AF, atrial fibrillation; CVD, cardiovascular disease.