New-Onset Atrial Fibrillation Is a Predictor of Subsequent Hyperthyroidism: A Nationwide Cohort Study

Christian Selmer; Morten Lock Hansen; Jonas Bjerring Olesen; Charlotte Mérie; Jesper Lindhardsen; Anne-Marie Schjerning Olsen; Jesper Clausager Madsen; Ulla Schmidt; Jens Faber; Peter Riis Hansen; Ole Dyg Pedersen; Christian Torp-Pedersen; Gunnar Hilmar Gislason

doi:10.1371/journal.pone.0057893

New-Onset Atrial Fibrillation Is a Predictor of Subsequent Hyperthyroidism: A Nationwide Cohort Study

Christian Selmer, Morten Lock Hansen, Jonas Bjerring Olesen, Charlotte Mérie, Jesper Lindhardsen, Anne-Marie Schjerning Olsen, Jesper Clausager Madsen, Ulla Schmidt, Jens Faber, Peter Riis Hansen, Ole Dyg Pedersen, Christian Torp-Pedersen, Gunnar Hilmar Gislason

Department of Clinical Medicine

15 Citations (Scopus)

Abstract

Aims: To examine the long-term risk of hyperthyroidism in patients admitted to hospital with new-onset AF. Hyperthyroidism is a well-known risk factor for atrial fibrillation (AF), but it is unknown whether new-onset AF predicts later-occurring hyperthyroidism. Methods and Results: All patients admitted with new-onset AF in Denmark from 1997-2009, and their present and subsequent use of anti-thyroid medication was identified by individual-level linkage of nationwide registries. Patients with previous thyroid diagnosis or thyroid medication use were excluded. Development of hyperthyroidism was assessed as initiation of methimazole or propylthiouracil up to a 13-year period. Risk of hyperthyroidism was analysed by Poisson regression models adjusted for important confounders such as amiodarone treatment. Non-AF individuals from the general population served as reference. A total of 145,623 patients with new-onset AF were included (mean age 66.4 years [SD ±13.2] and 55.3% males) of whom 3% (4,620 events; 62.2% women) developed hyperthyroidism in the post-hospitalization period compared to 1% (48,609 events; 82% women) in the general population (n = 3,866,889). In both women and men we found a significantly increased risk of hyperthyroidism associated with new-onset AF compared to individuals in the general population. The highest risk was found in middle-aged men and was consistently increased throughout the 13-year period of observation. The results were confirmed in a substudy analysis of 527,352 patients who had thyroid screening done. Conclusion: New-onset AF seems to be a predictor of hyperthyroidism. Increased focus on subsequent risk of hyperthyroidism in patients with new-onset AF is warranted.

Original language	English
Article number	e57893
Journal	P L o S One
Volume	8
Issue number	2
Pages (from-to)	1-9
Number of pages	9
ISSN	1932-6203
DOIs	https://doi.org/10.1371/journal.pone.0057893
Publication status	Published - 28 Feb 2013

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Selmer, C., Hansen, M. L., Olesen, J. B., Mérie, C., Lindhardsen, J., Olsen, A.-M. S., Madsen, J. C., Schmidt, U., Faber, J., Hansen, P. R., Pedersen, O. D., Torp-Pedersen, C., & Gislason, G. H. (2013). New-Onset Atrial Fibrillation Is a Predictor of Subsequent Hyperthyroidism: A Nationwide Cohort Study. P L o S One, 8(2), 1-9. Article e57893. https://doi.org/10.1371/journal.pone.0057893

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title = "New-Onset Atrial Fibrillation Is a Predictor of Subsequent Hyperthyroidism: A Nationwide Cohort Study",

abstract = "Aims: To examine the long-term risk of hyperthyroidism in patients admitted to hospital with new-onset AF. Hyperthyroidism is a well-known risk factor for atrial fibrillation (AF), but it is unknown whether new-onset AF predicts later-occurring hyperthyroidism. Methods and Results: All patients admitted with new-onset AF in Denmark from 1997-2009, and their present and subsequent use of anti-thyroid medication was identified by individual-level linkage of nationwide registries. Patients with previous thyroid diagnosis or thyroid medication use were excluded. Development of hyperthyroidism was assessed as initiation of methimazole or propylthiouracil up to a 13-year period. Risk of hyperthyroidism was analysed by Poisson regression models adjusted for important confounders such as amiodarone treatment. Non-AF individuals from the general population served as reference. A total of 145,623 patients with new-onset AF were included (mean age 66.4 years [SD ±13.2] and 55.3% males) of whom 3% (4,620 events; 62.2% women) developed hyperthyroidism in the post-hospitalization period compared to 1% (48,609 events; 82% women) in the general population (n = 3,866,889). In both women and men we found a significantly increased risk of hyperthyroidism associated with new-onset AF compared to individuals in the general population. The highest risk was found in middle-aged men and was consistently increased throughout the 13-year period of observation. The results were confirmed in a substudy analysis of 527,352 patients who had thyroid screening done. Conclusion: New-onset AF seems to be a predictor of hyperthyroidism. Increased focus on subsequent risk of hyperthyroidism in patients with new-onset AF is warranted.",

author = "Christian Selmer and Hansen, {Morten Lock} and Olesen, {Jonas Bjerring} and Charlotte M{\'e}rie and Jesper Lindhardsen and Olsen, {Anne-Marie Schjerning} and Madsen, {Jesper Clausager} and Ulla Schmidt and Jens Faber and Hansen, {Peter Riis} and Pedersen, {Ole Dyg} and Christian Torp-Pedersen and Gislason, {Gunnar Hilmar}",

year = "2013",

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doi = "10.1371/journal.pone.0057893",

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T1 - New-Onset Atrial Fibrillation Is a Predictor of Subsequent Hyperthyroidism

T2 - A Nationwide Cohort Study

AU - Selmer, Christian

AU - Hansen, Morten Lock

AU - Olesen, Jonas Bjerring

AU - Mérie, Charlotte

AU - Lindhardsen, Jesper

AU - Olsen, Anne-Marie Schjerning

AU - Madsen, Jesper Clausager

AU - Schmidt, Ulla

AU - Faber, Jens

AU - Hansen, Peter Riis

AU - Pedersen, Ole Dyg

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar Hilmar

PY - 2013/2/28

Y1 - 2013/2/28

N2 - Aims: To examine the long-term risk of hyperthyroidism in patients admitted to hospital with new-onset AF. Hyperthyroidism is a well-known risk factor for atrial fibrillation (AF), but it is unknown whether new-onset AF predicts later-occurring hyperthyroidism. Methods and Results: All patients admitted with new-onset AF in Denmark from 1997-2009, and their present and subsequent use of anti-thyroid medication was identified by individual-level linkage of nationwide registries. Patients with previous thyroid diagnosis or thyroid medication use were excluded. Development of hyperthyroidism was assessed as initiation of methimazole or propylthiouracil up to a 13-year period. Risk of hyperthyroidism was analysed by Poisson regression models adjusted for important confounders such as amiodarone treatment. Non-AF individuals from the general population served as reference. A total of 145,623 patients with new-onset AF were included (mean age 66.4 years [SD ±13.2] and 55.3% males) of whom 3% (4,620 events; 62.2% women) developed hyperthyroidism in the post-hospitalization period compared to 1% (48,609 events; 82% women) in the general population (n = 3,866,889). In both women and men we found a significantly increased risk of hyperthyroidism associated with new-onset AF compared to individuals in the general population. The highest risk was found in middle-aged men and was consistently increased throughout the 13-year period of observation. The results were confirmed in a substudy analysis of 527,352 patients who had thyroid screening done. Conclusion: New-onset AF seems to be a predictor of hyperthyroidism. Increased focus on subsequent risk of hyperthyroidism in patients with new-onset AF is warranted.

AB - Aims: To examine the long-term risk of hyperthyroidism in patients admitted to hospital with new-onset AF. Hyperthyroidism is a well-known risk factor for atrial fibrillation (AF), but it is unknown whether new-onset AF predicts later-occurring hyperthyroidism. Methods and Results: All patients admitted with new-onset AF in Denmark from 1997-2009, and their present and subsequent use of anti-thyroid medication was identified by individual-level linkage of nationwide registries. Patients with previous thyroid diagnosis or thyroid medication use were excluded. Development of hyperthyroidism was assessed as initiation of methimazole or propylthiouracil up to a 13-year period. Risk of hyperthyroidism was analysed by Poisson regression models adjusted for important confounders such as amiodarone treatment. Non-AF individuals from the general population served as reference. A total of 145,623 patients with new-onset AF were included (mean age 66.4 years [SD ±13.2] and 55.3% males) of whom 3% (4,620 events; 62.2% women) developed hyperthyroidism in the post-hospitalization period compared to 1% (48,609 events; 82% women) in the general population (n = 3,866,889). In both women and men we found a significantly increased risk of hyperthyroidism associated with new-onset AF compared to individuals in the general population. The highest risk was found in middle-aged men and was consistently increased throughout the 13-year period of observation. The results were confirmed in a substudy analysis of 527,352 patients who had thyroid screening done. Conclusion: New-onset AF seems to be a predictor of hyperthyroidism. Increased focus on subsequent risk of hyperthyroidism in patients with new-onset AF is warranted.

U2 - 10.1371/journal.pone.0057893

DO - 10.1371/journal.pone.0057893

M3 - Journal article

C2 - 23469097

SN - 1932-6203

VL - 8

SP - 1

EP - 9

JO - P L o S One

JF - P L o S One

IS - 2

M1 - e57893

ER -

New-Onset Atrial Fibrillation Is a Predictor of Subsequent Hyperthyroidism: A Nationwide Cohort Study

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