Jump to comment:

• To improve validity in population-based prospective cohort study: comment on the article by Wei et al.
  Tsung-Kun Lin, Tsung-Yuan Yang and Gwo-Ping Jong
  Published on: 17 May 2023

• Published on: 17 May 2023

  To improve validity in population-based prospective cohort study: comment on the article by Wei et al.

  • Tsung-Kun Lin, Professor School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, ROC
  • Other Contributors:
    • Tsung-Yuan Yang, Cardiology
    • Gwo-Ping Jong, Cardiology

  An article by Wei et al. reported the death of a child associated with an increased risk of incident atrial fibrillation (AF). The association was observed when the cause of death was both cardiovascular and non-cardiovascular diseases.1 These findings provide a valuable addition to the literature; however, some issues were not addressed by the authors.
  First, several clinical risk factors are associated with incident AF, including concurrent medication, illegal drugs, obesity, sleep apnea, and hyperthyroidism.2-4 For example, we previously reported that insulin users had a higher risk of incident AF than non-users among the elderly patients’ cohort (1.58 odds ratio (OR); 95% confidence interval (CI): 1.37–1.82). Patients with dipeptidyl peptidase 4 inhibitor (OR 0.65; 95% CI: 0.45–0.93) intake had a lower risk of developing AF when compared with non-users.4 However, while associated evaluations were not presented, Wei et al. did not exclude individuals with these risk factors. Consequently, confounding effects may have contributed to the significant effects causing incident AF, thus, omitting these effects may improve study validation outcomes.
  Second, the study initially enrolled 2,740,028 participants in the unexposed group and 64,216 participants in the exposed group at baseline, but missing data between groups (50.1% vs. 79.6%) were examined in further analyses. These missing data potentially affected data credibility in mediation analyses.5 Consequent...

  Show More

  An article by Wei et al. reported the death of a child associated with an increased risk of incident atrial fibrillation (AF). The association was observed when the cause of death was both cardiovascular and non-cardiovascular diseases.1 These findings provide a valuable addition to the literature; however, some issues were not addressed by the authors.
  First, several clinical risk factors are associated with incident AF, including concurrent medication, illegal drugs, obesity, sleep apnea, and hyperthyroidism.2-4 For example, we previously reported that insulin users had a higher risk of incident AF than non-users among the elderly patients’ cohort (1.58 odds ratio (OR); 95% confidence interval (CI): 1.37–1.82). Patients with dipeptidyl peptidase 4 inhibitor (OR 0.65; 95% CI: 0.45–0.93) intake had a lower risk of developing AF when compared with non-users.4 However, while associated evaluations were not presented, Wei et al. did not exclude individuals with these risk factors. Consequently, confounding effects may have contributed to the significant effects causing incident AF, thus, omitting these effects may improve study validation outcomes.
  Second, the study initially enrolled 2,740,028 participants in the unexposed group and 64,216 participants in the exposed group at baseline, but missing data between groups (50.1% vs. 79.6%) were examined in further analyses. These missing data potentially affected data credibility in mediation analyses.5 Consequently, the results should be interpreted with caution and not influence teaching or clinical practice before the findings are comprehensively replicated. We suggest performing sensitivity tests on parents of live-born children in 1991–2016, in the Danish Medical Birth Register, to improve study validation.
  In conclusion, although we raised some concerns with Wei et al.1, we applaud the authors for their commendable work and hope this study will benefit readers, clinicians, and patients. We look forward to further work on the early prevention of incident AF and hope that early preventive approaches will benefit bereaved parents.

  Contributors TKL, TYY and GPJ wrote the manuscript. GPJ contributed to the final version of the manuscript. TYY and GPJ supervised the project.

  Funding None.

  Competing interests None declared.

  Patient consent for publication Not applicable.

  Provenance and peer review: Not commissioned; internally peer reviewed.

  ORCID iDs
  Gwo-Ping Jong http://orcid.org/0000-0002-7786-5497

  References:
  1. Wei D, Janszky I, Li J, et al. Loss of a child and the risk of atrial fibrillation: a Danish population-based prospective cohort study. J Epidemiol Community Health 2023;77:322-7.
  2. Dai H, Zhang Q, Much AA, et al. Global, regional, and national prevalence, incidence, mortality, and risk factors for atrial fibrillation, 1990–2017: results from the Global Burden of Disease Study 2017. Eur Heart J Qual Care Clin Outcomes 2021;7:574–82.
  3. Fauchier L, Clementy N, Babuty D. Statin therapy and atrial fibrillation: systematic review and updated meta-analysis of published randomized controlled trials. Curr Opin Cardiol 2013;28:7-18.
  4. Chen HY, Yang FY, Jong GP, et al. Antihyperglycemic drugs use and new-onset atrial fibrillation in elderly patients. Eur J Clin Invest 2017;47:388-93.
  5. Tsvetanova A, Sperrin M, Peek N, et al. Missing data was handled inconsistently in UK prediction models: a review of method used. J Clin Epidemiol 2021;140:149-58.

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top