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Citation
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Alcover KC, Ambardar SR, Poltavskiy E, Nasir JM, Janak JC, Howard JT, Walker LE, Haigney MC, Stewart IJ. J. Cardiovasc. Electrophysiol. 2021; ePub(ePub): ePub. |
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Abstract
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INTRODUCTION: Atrial Fibrillation and Atrial Flutter (AF/AFL), the most common atrial arrhythmias, have never been examined in combat casualties. In this study, we investigated the impact of traumatic injury on AF/AFL among service members with deployment history.
METHODS: Sampled from the Department of Defense (DoD) Trauma Registry (n=10,000), each injured patient in this retrospective cohort study was matched with a non-injured service member drawn from the Veterans Affairs/DoD Identity Repository. The primary outcome was AF/AFL diagnosis identified using ICD-9-CM and ICD-10-CM codes. Competing risk regressions based on Fine and Gray subdistribution hazards model with were utilized to assess the association between injury and AF/AFL.
RESULTS: There were 130 reported AF/AFL cases, 90 of whom were injured and 40 were non-injured. The estimated cumulative incidence rates of AF/AFL for injured was higher compared to non-injured patients (HR = 2.04; 95% CI = 1.44, 2.87). After adjustment demographics and tobacco use, the association did not appreciably decrease (HR = 1.90; 95% CI = 1.23, 2.93). Additional adjustment for obesity, hypertension, diabetes, and vascular disorders, the association between injury and AF/AFL was no longer statistically significant (HR: 1.51; 95% CI = 0.99, 2.52).
CONCLUSION: Higher AF/AFL incidence rate was observed among deployed service members with combat injury compared to servicemembers without injury. The association did not remain significant after adjustment for cardiovascular-related covariates. These findings highlight the need for combat casualty surveillance to further understand the AF/AFL risk within the military population and to elucidate the potential underlying pathophysiologic mechanisms. UNSTRUCTURED ABSTRACT: Atrial fibrillation and atrial flutter have never been examined in combat casualties. In this study, we investigated the impact of traumatic injury on AF/AFL among service members with deployment history. A retrospective cohort of injured patients (n =10,000) was sampled from the Department of Defense (DoD) Trauma Registry. Each injured patient was matched with a non-injured service member drawn from the Veterans Affairs/DoD Identity Repository. The AF/AFL diagnosis was identified using ICD-9-CM and ICD-10-CM codes. To assess the association between injury and AF/AFL, competing risk regressions based on Fine and Gray subdistribution hazards model were utilized. In this cohort, 130 patients were reported AF/AFL cases (90 were injured and 40 were non-injured). The incidence rate of AF/AFL for injured was higher compared to non-injured patients (HR = 2.04; 95% CI = 1.44, 2.87). After adjustment for demographics and tobacco use, the association did not appreciably decrease (HR = 1.90; 95% CI = 1.23, 2.93). Additional adjustment for obesity, hypertension, diabetes, and vascular disorders, the association between injury and AF/AFL was no longer statistically significant (HR: 1.51; 95% CI = 0.99, 2.52). Higher AF/AFL incidence rate was observed among deployed service members with combat injury compared to service members without injury. The association did not remain significant after adjustment for cardiovascular-related covariates. These findings highlight the need for combat casualties surveillance to further understand the AF/AFL risk within the military population and to elucidate the potential underlying pathophysiologic mechanisms. This article is protected by copyright. All rights reserved.
Language: en |