“It is remarkable to find that patients with diabetes had a reduced recognition of atrial fibrillation symptoms,” said study author Tobias Reichlin, MD, professor of cardiology at Bern University Hospital at the University of Bern in Switzerland, in a release from the AHA. The heart rate in afib can range between 100 to 175 beats a minute; the normal range for a heart rate is typically 60 to 100 beats a minute, according to Mayo Clinic. “The reduced perception of atrial fibrillation symptoms may result in a delayed diagnosis of atrial fibrillation, and, consequently, more complications such as stroke,” said Dr. Reichlin.
The Connection Between Afib and Diabetes
Atrial fibrillation can lead to stroke, blood clots, heart failure, and other heart-related conditions, according to the AHA. It’s estimated that at least 2.7 million Americans have afib, which is a quivering or irregular heartbeat (arrhythmia), though the true number may be higher than that, according to Chirag Barbhaiya, MD, cardiac electrophysiologist and researcher at NYU Langone Health in New York City. Dr. Barbhaiya was not involved in this research. “It’s hard to get a good estimate of the actual number of people with atrial fibrillation because there are so many people that have it and don’t know it,” he says. An additional challenge is that the definition of afib can also vary, says Barbhaiya. “We find that the more closely we are able to monitor people’s heartbeat, the more often we see these very short episodes of atrial fibrillation; it’s not well established how long an episode of afib has to last before you should be put in a category such that you should treated for it,” he explains. There are many risk factors associated with developing afib, including age, genetics, race, smoking, obesity, and diabetes. People with diabetes have a 40 percent higher risk for developing afib compared with people without diabetes, according to research published in the Journal of General Internal Medicine. Studying the relationship between these two groups is important because both diabetes and atrial fibrillation are problems that are becoming more prevalent in the population, says Barbhaiya. Sometimes people have afib and don’t know it because they don’t have any symptoms, or they don’t recognize them, per the AHA. Common symptoms include being tired and weak, rapid and irregular heartbeat or fluttering in the chest, and shortness of breath and anxiety.
People With Afib and Diabetes at Higher Risk for High Blood Pressure and Stroke
Because diabetes is a major risk factor for afib, investigators aimed to find out whether people with diabetes had different symptoms and complications for atrial fibrillation compared with people without diabetes. The study participants were 2,411 patients diagnosed with atrial fibrillation who were enrolled at 14 healthcare centers in Switzerland from 2014 to 2017 as part of the Swiss-AF (Swiss Atrial Fibrillation) Study. The average age of the subjects was 73.2, and 27.4 percent were women. At the onset of the study, each participant had a medical exam, which included blood sampling, cognitive assessment, quality of life assessment, and five-minute resting ECG (electrocardiogram). A total of 17.4 percent of the participants either took diabetes medication or had a diagnosis of diabetes in their medical records. Researchers then compared afib symptoms, quality of life outcomes, cardiac comorbidities, and neurological comorbidities between the groups with and without diabetes.
People with diabetes were about 25 percent less likely than those without diabetes to recognize common symptoms of atrial fibrillation, such as a rapid heartbeat.The likelihood of having additional issues related to heart health was higher in the diabetes group; People with diabetes were:3 times more likely than those without diabetes to have high blood pressure55 percent more likely to have had heart attacks2 times more likely to have heart failurePeople with diabetes had a 39 percent increased risk of having a stroke and were 75 percent more likely to have cognitive impairment.
In quality of life measures, investigators found that that afib adversely impacted mobility, self-care and normal activities more for people with diabetes. These findings show that people with diabetes who also had afib were less likely to experience any symptom related to afib, despite having more coexisting health conditions related to the heart, said Prakash Deedwania, MD, professor of medicine at the University of California in San Francisco School of Medicine and a member of the scientific advisory board for Know Diabetes By Heart (KDBH), a joint initiative of the AHA and the American Diabetes Association, in the release. “Keeping these new observations in mind, along with the serious consequences of failing to recognize afib in time, it seems prudent to consider screening older patients with diabetes for afib so that treatment may be initiated when appropriate,” he said. It may take a study that proves that screening for afib in people with diabetes improves outcomes, such as fewer strokes, before guidelines are changed, says Barbhaiya. “The take-home message here is that the symptoms that patients often develop from atrial fibrillation can be less severe or different if present at all in patients with diabetes,” he says. “If someone with diabetes is having symptoms that are otherwise not well explained — for example, if they are having shortness of breath or feeling more fatigued that usual — then as a provider, I would have a very low threshold for screening for afib,” says Barbhaiya. The authors acknowledge limitations to the study were limitations to the study. Data wasn’t available on how long the participants had been living with diabetes or how well their diabetes was controlled. Because the study only included residents of Switzerland, the findings may not be generalizable to other populations or ethnic groups.
