Abstract 13834: Prognosis of Patients with Atrial Fibrillation and Weight Loss: the Fushimi AF Registry

Background: Atrial fibrillation (AF) is a common cardiac arrythmia in the elderly, in whom frailty is often a clinical issue. Weight loss is one of the key factors of frailty, and we previously reported that low body wight (≤50 kg) was associated with higher mortality and morbidity in patients with AF. However, the association of weight loss with prognosis of AF patients is unclear. Methods: The Fushimi AF registry is a community based prospective survey of AF patients in Japan. We collected data on body weight annually, and changes in body weight were obtained in 2,922 patients (mean age, 73 years; female 39.3%; mean body weight 59.8 kg). We defined weight loss as decrease in body weight ≥ 4.5 kg or 5% in the past year based on the frailty-defining criteria in the Cardiovascular Health Study. Results: During the follow-up, 1319 patients had weight loss (7.9% per person-year). Patients with weight loss were older, and had more hypertension, diabetes, coronary artery disease, chronic kidney disease, and heart failure at baseline than those without. Prevalence of prior stroke/systemic embolisms (SE) and major bleeding were similar between patients with and without weight loss. In the logistic regression analysis, hypertension, diabetes, chronic kidney disease, and heart failure were positively associated with development of weight loss, and incidence of stroke/SE was inversely associated with weight loss. Landmark analysis after the onset of weight loss revealed that patients with weight loss showed significantly higher incidence of all-cause death and cardiac death. Incidence of heart failure hospitalization, stroke/SE, and major bleeding were comparable between patients with and without weight loss. After adjustment for clinical confounders, weight loss was significantly associated with the incidence of all-cause death (hazard ratio, 1.79; 95% confidence interval, 1.54-2.09) and cardiac death (hazard ratio, 1.67; 95% confidence interval, 1.15-2.43). Subgroup analyses revealed that weight loss was also significantly associated with higher all-cause and cardiac mortality regardless of age, sex, and body weight at baseline. Conclusion: In AF patients, weight loss was significantly associated with higher all-cause and cardiac mortality.