Incident Heart Failure and Atrial Fibrillation after a Community Diagnosis of Nonalcoholic Fatty Liver Disease: A Matched Retrospective Cohort Study with Competing-Risk Analysis

Abstract

Background/Objectives: Heart failure and atrial fibrillation are studied far less often than ischaemic endpoints in nonalcoholic fatty liver disease, and published cohorts censor deaths rather than modelling them. We estimated the association with incident heart failure. Methods: In a county records-linkage population, adults first diagnosed in 1997-2014 were matched on age and sex to up to four referents sharing their index date. A first heart-failure record was analysed by Cox regression stratified on matched set and adjusted for index-date cardiometabolic conditions, and by Fine-Gray and Aalen-Johansen estimators with death as competing event. Results: Among 15,512 subjects at risk, 597 records accrued. The adjusted hazard ratio was 1.40 (95% CI 1.12–1.74), the sub-distribution hazard ratio 1.21 (95% CI 0.99–1.49), and ten-year cumulative incidence 2.0 (95% CI 0.8–3.2) percentage points higher in exposed subjects. The association was concentrated in those without a recorded cardiometabolic condition (interaction p = 0.005) and attenuated after adjustment for imputed body-mass index. Atrial fibrillation showed no adjusted association (1.01 (95% CI 0.81–1.26)). Conclusions: The diagnosis was associated with a moderately higher rate of recorded heart failure but not atrial fibrillation; the absolute ten-year excess was modest, and shared adiposity and differential clinical attention remain plausible explanations.

Keywords

• non-alcoholic fatty liver disease
• metabolic dysfunction-associated steatotic liver disease
• heart failure
• atrial fibrillation
• cohort studies
• competing risks
• cumulative incidence
• medical record linkage