![]() ![]() The NRP contains data with regard to all discharges from all nonpsychiatric hospitals since 1977 and with regard to emergency department and outpatient clinic visits since 1995. We did not include patients with any earlier diagnosis of atrial fibrillation or flutter registered in the NRP. We used the NRP to identify all patients with an incident hospital diagnosis of atrial fibrillation or flutter from January 1, 1999, through December 31, 2005. To address the limitations in the existing literature, we therefore conducted a large, population-based, case-control study to examine whether and to what extent use of systemic glucocorticoids is associated with increased risk of atrial fibrillation or flutter. 9īecause atrial fibrillation is associated with severe complications and glucocorticoids are widely used, an association between glucocorticoids and atrial fibrillation has major public health implications. 9, 10 However, the interpretation of these studies was hampered by restriction to COPD patients, 10 incomplete participation, 9 and relatively small sample size which yielded statistically imprecise risk estimates for subgroups. 7, 8 The 2 case-control studies, which involved 385 and 468 atrial fibrillation cases from the Netherlands and the United Kingdom, respectively, found an increased risk of atrial fibrillation among users of systemic glucocorticoids. Both case reports described episodes of atrial fibrillation after methylprednisolone pulse therapy. 6 The existing literature with regard to glucocorticoid use and atrial fibrillation consists of 2 case reports and 2 case-control studies. 5 It is associated with increased mortality and morbidity, mainly because of a 3- to 4-fold increased risk of ischemic stroke. 4 Atrial fibrillation is a common cardiac arrhythmia whose prevalence is above 10% in men 80 years or older. 2, 3 Treatment with high-dose glucocorticoids has been reported to increase the risk of myocardial infarction, stroke, and heart failure. 1 Glucocorticoid use has several adverse effects that are established risk factors for atherosclerosis, such as hypertension, sodium and fluid retention, diabetes mellitus, and dyslipidemia. Glucocorticoids are widely used in the treatment of inflammatory and autoimmune diseases, such as chronic obstructive pulmonary disease (COPD), asthma, rheumatoid arthritis (RA), connective tissue diseases, inflammatory bowel diseases, chronic hepatitis, glomerulonephritis, and malignant neoplasms, as well as in organ transplantations. Former glucocorticoid use was not associated with increased risk (adjusted OR, 1.00 95% CI, 0.96-1.06).Ĭonclusion Current glucocorticoid use was associated with an almost 2-fold increased risk of atrial fibrillation or flutter. The increased risk remained robust in patients with and without pulmonary and cardiovascular diseases. Among new glucocorticoid users, the adjusted OR was 3.62 (95% CI, 3.11-4.22) and among long-term users it was 1.66 (95% CI, 1.53-1.80). Current glucocorticoid use was associated with an increased risk of atrial fibrillation or flutter compared with never use (adjusted OR, 1.92 95% confidence interval, 1.79-2.06). Among 202 130 population controls, 5245 (2.6%) were current glucocorticoid users and 19 940 (9.9%) were former users. Results Among 20 221 patients with atrial fibrillation or flutter, 1288 (6.4%) were current glucocorticoid users and 2375 (11.7%) were former users. We used conditional logistic regression to compute odds ratios (ORs), controlling for potential confounders. We obtained data on glucocorticoid prescriptions within 60 days (current users) or longer before the index date (former users), comorbidity, and medications from medical databases. For each case we selected 10 population controls matched by age and sex. ![]() Methods For this population-based, case-control study, we identified all patients with a first hospital diagnosis of atrial fibrillation or flutter from January 1, 1999, through December 31, 2005, in Northern Denmark (population, 1.7 million). We examined whether glucocorticoid use is associated with the risk of atrial fibrillation or flutter. Shared Decision Making and Communicationīackground Glucocorticoid use is associated with increased risk of myocardial infarction, stroke, and heart failure, but data are limited on the risk of atrial fibrillation or flutter.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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