The NHIS database includes each subject’s demographic information, diagnoses, their use of inpatient and outpatient services, and prescription claims. The NHIS is a mandatory health insurance program managed by the Korean government, which covers 97% of the Korean population (approximately 50 million people). We used data from the national health claims database provided by the National Health Insurance Service (NHIS). This study suggests that maintaining Hb levels within the normal ranges confers a low risk of AF development. In conclusion, low or high Hb levels are associated with an increased risk of incident AF. Among individuals with Hb levels within normal ranges (13–15.9 g/dL in men and 12–14.9 g/dL in women), both decrease and increase in Hb levels at the second measurement outside the normal ranges showed an elevation of AF risk by 11% and 21% for men and 3% and 36% for women, respectively, compared with those who maintained normal Hb levels. AF incidence was lowest at Hb levels of 14–14.9 g/dL in men and 12–12.9 g/dL in women. However, Hb levels showed a U-shaped association with incident AF after adjustment for cardiovascular risk factors. The presence of anemia (Hb level <13 g/dL in men and <12 g/dL in women) was a significant risk factor for AF development. These subjects were followed up until 2017 to determine AF development. We retrospectively analyzed a cohort from the Korean National Health Insurance Service database and identified 9,686,314 subjects (49.8% male) without a history of AF, aged ≥40 years, and with Hb levels available for both first (2009–2010) and second (2011–2012) health checkups. In this study, we investigated the effect of hemoglobin (Hb) levels and their changes on the risk of AF development in the general population of Korea.
Anemia is a risk factor for cardiovascular disease, but its impact on new-onset atrial fibrillation (AF) is unclear.
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