Dulaglutide and Incident Atrial Fibrillation or Flutter in patients with type 2 Diabetes; a post-hoc analysis from the REWIND Randomized Trial

Diabetes mellitus is an independent risk factor for atrial fibrillation or atrial flutter (atrial arrythmia, AA). Additionally, some diabetes medications may influence AA incidence. The aim of this post hoc analysis was to assess the occurrence of AA during the study period in patients with type 2 diabetes treated with once weekly subcutaneous dulaglutide vs placebo in the REWIND study.

Materials and Methods
Patients without electrocardiographic (ECG) confirmed AA at baseline and randomised in the REWIND trial were assessed for the development of AA based on an annual ECG. Additional analyses included whether dulaglutide compared to placebo reduced the composite outcome of AA or death, AA or CV death, AA or stroke and AA or heart failure.

Results
Among 9543 participants (mean age 66 ± 7 years, with cardiovascular risk factors and 31% with previous cardiovascular disease) without AA at entry in the trial, 524 patients (5.5%) had at least one episode of AA during the median 5.4 years of follow-up. Incident AA occurred in 269 of the 4769 participants allocated to dulaglutide (5.6%), at a rate of 10.7 per 1000 person-years, vs. 255 of the 4774 allocated to placebo (5.3%) at a rate of 10.5 per 1000 person-years (p=0.59). There was also no effect of dulaglutide on the composite outcome of AA and death or AA and heart failure.

Conclusion
This post hoc analysis of data from the REWIND trial showed that treatment with dulaglutide was not associated with a reduced incidence of AA in this at-risk group of patients with type 2 diabetes.

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