Atrial fibrillation (AF) conveys profound morbidity and mortality and is principally a disease of advanced age. Subclinical AF results in debilitating outcomes in older adults. There has been markedly limited study of the relation of AF to physical performance and functional status, established metrics of adverse age-related decline. Our central hypothesis is that AF contributes significantly to declining physical performance and functional status in older adults. Our long-term goals are two-fold: to examine how AF exacerbates functional limitations, and ultimately to determine if earlier identification of subclinical AF can mitigate its impact on such processes. The present investigations will examine the cross-sectional and prospective relations of AF to functional assessments in the biracial Health, Aging, and Body Composition (Health ABC) Study, consisting in 3,075 well-functioning older adults (70-79 years). As a complementary aim, the investigations will develop an innovative pilot and feasibility study examining subclinical AF in a cohort of home-bound older adults selected from the Boston University Geriatrics Home-Care Program (mean age 84.2, 54% African American).
Aim 1 will examine the cross-sectional relations of AF to physical performance and functional status in Health ABC at the baseline exam and years 4, 6, 8 and 10.
Aim 2 will determine the prospective relation of AF to longitudinal changes in measures of physical performance and functional status across Health ABC exams.
Aim 3 will employ an unobtrusive 7-day cardiac rhythm monitor in home-bound older adults (n=100), establishing pilot and feasibility data for detection of subclinical AF. The proposed studies will fill important gaps in AF and geriatric epidemiology. Determining the relation of AF to age-related decline in physical performance and functional status has important implications for earlier detection and treatment of AF to prevent such decline. Detecting subclinical AF in home-bound, frail older adults may prompt evidence-based interventions (i.e. stroke prevention) that reduce the severe morbidity associated with AF. These investigations will contribute towards an expanded study to examine the prevalence of subclinical AF in a larger cohort of home-bound older adults and determine its prospective relation to adverse outcomes. Key mentoring in geriatric research and AF and integration in the Boston Claude Pepper Older Americans Independence Center will enhance the proposed investigations. 9/27/2012

Public Health Relevance

The proposed investigations are relevant to public health by (1) examining the relation of atrial fibrillation (AF) to measures of physical performance and functional status in older adults and (2) determining the prevalence of subclinical AF in vulnerable home-bound older adults. Understanding the contribution of AF to functional decline may prompt new interventions to treat AF in order to limit disability related to aging. Detection o subclinical AF has immediate relevance for prevention of complications such as stroke or heart failure.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Small Research Grants (R03)
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Special Emphasis Panel (ZAG1)
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Zieman, Susan
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Boston University
Internal Medicine/Medicine
Schools of Medicine
United States
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Magnani, Jared W; Wang, Na; Benjamin, Emelia J et al. (2016) Atrial Fibrillation and Declining Physical Performance in Older Adults: The Health, Aging, and Body Composition Study. Circ Arrhythm Electrophysiol 9:e003525
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Rahman, Faisal; Yin, Xiaoyan; Larson, Martin G et al. (2016) Trajectories of Risk Factors and Risk of New-Onset Atrial Fibrillation in the Framingham Heart Study. Hypertension 68:597-605
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Magnani, Jared W (2015) Risk assessment for atrial fibrillation: Enter the P-wave. Heart Rhythm 12:1896-7
Dewland, Thomas A; Vittinghoff, Eric; Harris, Tamara B et al. (2015) Inflammation as a Mediator of the Association Between Race and Atrial Fibrillation: Results from the Health, Aging, and Body Composition Study. JACC Clin Electrophysiol 1:248-255
Ho, Jennifer E; Magnani, Jared W (2015) The MESA heart failure risk score: can't we do more? Heart 101:7-9
Magnani, Jared W; Brody, Jennifer A; Prins, Bram P et al. (2014) Sequencing of SCN5A identifies rare and common variants associated with cardiac conduction: Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium. Circ Cardiovasc Genet 7:365-73
Driver, Todd H; Katz, Ronit; Ix, Joachim H et al. (2014) Urinary kidney injury molecule 1 (KIM-1) and interleukin 18 (IL-18) as risk markers for heart failure in older adults: the Health, Aging, and Body Composition (Health ABC) Study. Am J Kidney Dis 64:49-56
Magnani, Jared W; Moser, Carlee B; Murabito, Joanne M et al. (2014) Association of sex hormones, aging, and atrial fibrillation in men: the Framingham Heart Study. Circ Arrhythm Electrophysiol 7:307-12

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