Alcohol use disorder and clinical outcomes in atrial fibrillation: a nationwide cohort study
M Vanhanen, J Jaakkola, K E J Airaksinen, O Halminen, J Putaala, V Langen, P Mustonen, J Haukka, J Hartikainen, A Luojus, M Niemi, M Linna, M Lehto, K TeppoAbstract
Background
Alcohol use disorders (AUD) are common and associated with significant multimorbidity, as well as increased risks of ischemic stroke and bleeding. In patients with atrial fibrillation (AF), stroke prevention is therefore crucial, but the impact of AUD on clinical outcomes—including ischaemic stroke, death, intracranial haemorrhage, and other major bleeding—remains unclear.
Purpose
Our study aims to address this knowledge gap by exploring whether AUD is associated with poorer outcomes in patients with AF, using a nationwide dataset.
Methods
The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) registry includes data on 229,565 patients diagnosed with incident AF in Finland between 2007 and 2018, identified from national registries covering all levels of care. The definition of AUD was based on ICD-10 and ICPC-2 codes from all levels of care to enhance the comprehensive identification of patients likely affected by AUD. The main outcomes were ischaemic stroke, death, intracranial haemorrhage and other major bleeding and their occurrence was compared between patients with and without AUD.
Results
The mean age of patients was 72.7 years and 50% were female. Patients with AUD demonstrated a higher prevalence of diabetes, liver failure, renal failure, and previous bleeding. Patients with AUD had consistently higher incidence rates of all clinical outcomes compared with those without AUD. After adjustment for confounders, AUD remained independently associated with increased risks of ischaemic stroke (incidence rate ratio [IRR] 1.48; 95% CI 1.35–1.62), death (IRR 1.37; 95% CI 1.32–1.43), intracranial haemorrhage (IRR 1.76; 95% CI 1.57–1.98), and any major bleeding (IRR 1.54; 95% CI 1.44–1.64). Figure 1 shows the cumulative incidence curves for these outcomes.
Conclusion
This nationwide cohort study demonstrated that AUD is a major risk factor for ischaemic stroke, death, intracranial bleeding and other major bleeding among patients with AF. Accounting for AUD is essential for accurate risk stratification and balanced management of patients with AF.