Age-Specific Incidence, Outcome, Cost, and Projected Future Burden of Atrial Fibrillation–Related Embolic Vascular Events

Abstract

Background-Prevalence of atrial fibrillation (AF) is >10% at age ≥80 years, but the impact of population aging on rates of AF-related ischemic events is uncertain. Methods and Results-We studied age-specific incidence, outcome, and cost of all AF-related incident strokes and systemic emboli from 2002 to 2012 in the Oxford Vascular Study (OXVASC). We determined time trends in incidence of AF-related stroke in comparison with a sister study in 1981 to 1986, extrapolated numbers to the UK population and projected future numbers. Of 3096 acute cerebral or peripheral vascular events in the 92 728 study population, 383 incident ischemic strokes and 71 systemic emboli were related to AF, of which 272 (59.9%) occurred at ≥80 years. Of 597 fatal or disabling incident ischemic strokes, 262 (43.9%) were AF-related. Numbers of AF-related ischemic strokes at age ≥80 years increased nearly 3-fold from 1981-1986 to 2002-2012 (extrapolated to the United Kingdom: 6621 to 18 176 per year), due partly to increased age-specific incidence (relative rate 1.52, 95% confidence interval 1.31-1.77, P=0.001), with potentially preventable AF-related events at age ≥80 years costing the United Kingdom £374 million per year. At current incidence rates, numbers of AF-related embolic events at age ≥80 years will treble again by 2050 (72 974/year), with 83.5% of all events occurring in this age group. Conclusions-Numbers of AF-related incident ischemic strokes at age ≥80 years have trebled over the last 25 years, despite the introduction of anticoagulants, and are projected to treble again by 2050, along with the numbers of systemic emboli. Improved prevention in older people with AF should be a major public health priority. Yiin et al Burden of AF-Related Embolic Vascular Events 1237ischemic strokes tend to be severe and to incur high mean costs, 4 and noncerebral systemic embolism secondary to AF is also a major clinical burden. 5,6 With 2.3 million people estimated to have AF in the United States, 7 with prevalence increasing from 0.5% at 50 to 59 years to 10% at ≥80 years, and with age-specific prevalence possibly also increasing, [7][8][9] the burden and cost of AF-related stroke and systemic embolism could increase dramatically. However, anticoagulation with warfarin is highly effective in primary prevention of AF-related embolic events, 10,11 and several new oral anticoagulants may be of at least equivalent clinical benefit, 12 albeit with some disadvantages.13,14 Yet, there is widespread underuse of warfarin for AF, [15][16][17] particularly in the elderly. [18][19][20] Although there are few published data on the safety of newer anticoagulants at age ≥80 years, 12,21 there is good evidence that warfarin is more effective than aspirin in primary prevention in high-risk elderly patients with AF. 22 We could therefore be facing a substantial increase in potentially preventable AF-related embolic events at older ages because of the multiplicative effects of increased life expectancy, the strongly age-related prevalence of AF with no...

Incidence and functional outcome of atrial fibrillation and non-atrial fibrillation- related cardioembolic stroke in Joinville, Brazil: a population-based study

“…Anticoagulation prescription at hospital discharge in patients with atrial fibrillation and non-atrial fibrillation cardioembolic ischemic stroke in Joinville, 2015. strata. Distinct socio-economic and ethnic profiles and diagnostic work-up (i.e., proportion of undetermined ischemic strokes) could also explain these diferences 1,9,24 . Unfortunately, many CE events could have been prevented.…”

Global Burden of Thrombosis

“…In the Oxford Vascular Study in the United Kingdom, 43.9% (262/597) fatal or disabling strokes were related to atrial fibrillation. 42 Between 1981 and 2012, the number of atrial fibrillation-related ischemic strokes tripled in the United Kingdom. 42 The increasing prevalence of atrial fibrillation and its population impact (DALYs) likely reflects the convergence of 3 major factors: (1) global population increase and population aging, with increased life expectancies (especially >75 years of age), (2) the impact of obesity on increasing prevalence of diabetes mellitus (a key risk factor), and (3) success in reducing the mortality from ischemic heart disease, with a larger population surviving with key risk factors for atrial fibrillation, including coronary artery disease, congestive heart failure, and hypertension.…”

Oral anticoagulant therapy for older patients with atrial fibrillation: a review of current evidence

“…This is particularly relevant in the growing elderly population [1,2]. Indeed, AF-related incident ischemic strokes in patients over 80 years of age have trebled during the last 25 years, despite an increasing use of oral anticoagulants [42].…”