%0 Journal Article %T Traumatic injury and atrial fibrillation among deployed service members %J Journal of cardiovascular electrophysiology %D 2021 %A Alcover, Karl C. %A Ambardar, Shiva R. %A Poltavskiy, Eduard %A Nasir, Javed M. %A Janak, Jud C. %A Howard, Jeffrey T. %A Walker, Lauren E. %A Haigney, Mark C. %A Stewart, Ian J. %V ePub %N ePub %P ePub-ePub %X 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

%G en %I John Wiley and Sons %@ 1045-3873 %U http://dx.doi.org/10.1111/jce.15139