Regular exercise after a diagnosis of atrial fibrillation and lower risks of cardiovascular disease: a nationwide population-based study

Abstract Introduction There is a paucity of information about cardiovascular impacts related to the change of exercise habit after a new diagnosis of atrial fibrillation (AF). We aimed to investigate the influence of exercise on the risk of cardiovascular outcomes, such as ischemic stroke, heart failure (HF), and all-cause death, in patients with AF. Methods We included 66,692 patients with newly diagnosed AF (36.4% female, mean age 59.5 years, mean CHA2DS2-VASc 1.9) who underwent two serial health examinations before and after diagnosis of AF from 2010 to 2016, as provided by Korean National Health Insurance Corporation. The individuals self-reported a degree and frequency of exercise by questionnaires and doing vigorous physical activities ≥3 times/week or moderate physical activities ≥5 times/week was defined as a regular exercise group. The study population was divided into four categories according to the status of regular exercise before and after AF diagnosis: persistent non-exerciser (64.0%), new exerciser (13.4%), exercise drop-outs (12.5%), and exercise maintainer (10.1%). The primary outcomes were ischemic stroke, HF, and all-cause death during the follow-up. Results During a median 3.4 years follow-up, ischemic stroke, HF, and all-cause death occurred in 1905, 13112, and 2627 patients, respectively (incidence rates 8.5, 64.8, and 11.5 per 1,000 person-years, respectively). The change in exercise habits did not have a significant association with the risk of ischemic stroke (Figure 1). Regarding HF, those who newly initiated or maintained exercise after AF diagnosis showed a lower risk than those who do not exercise: hazard ratio, HR 0.93; 95% confidence interval, CI [0.88 to 0.98] and 0.90 [0.85 to 0.96] for each group, all p<0.001. Any experience of exercise involvement was associated with a lower risk of mortality than those without exercise: HR 0.76 [0.68–0.87] for new exerciser, 0.87 [0.78–0.98] for exercise drop-outs, and 0.62 [0.53–0.73] for exercise maintainer, all p<0.0001. Conclusions Patients who started or continued exercising after a new diagnosis of AF showed a lower risk of HF and mortality, but did not show an association with ischemic stroke. Regular exercise might improve the cardiovascular outcomes in patients with newly diagnosed AF. Figure 1. CV impacts of exercise on AF patients Funding Acknowledgement Type of funding source: None