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Loss of a child and the risk of atrial fibrillation: a Danish population-based prospective cohort study
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  • Published on:
    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...

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    Conflict of Interest:
    None declared.