Temporal trends and patterns in atrial fibrillation incidence: a population-based study of 3.4 million individuals

Abstract

Background Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide; confers an increased risk of adverse outcomes and once diagnosed most patients will require lifelong-treatment. Population-based studies of AF incidence are needed to inform health-service planning. However, few reports refer to a standard population and estimates of incidence in high income countries vary by over 12-fold. Purpose We aimed to assess trends in the crude and standardised atrial fibrillation incidence by sex, age, socioeconomic status and region in a large general population cohort from England. We also investigated the comorbidity profile of patients over almost two decades. Methods We used linked primary and secondary electronic health records of 3.4 million individuals from the Clinical Practice Research Datalink (CPRD). The CPRD database contains anonymised patient data from approximately 7% of the UK population and is broadly representative in terms of age, sex, and ethnicity. Eligible patients aged 16 years and older contributed data between Jan 1 1998 and Dec 31 2017. We defined incident AF diagnosis as the first record of AF in primary care or hospital admission records from any diagnostic position. For incidence calculations, we excluded all individuals who had a diagnosis of AF before the study start date, or within the first 12 months of registration with their general practice. For patients with incident AF, we extracted baseline characteristics, comorbidities, socioeconomic status and geographic region. We calculated standardised rates by applying direct age and sex standardisation to the 2013 European Standard Population. We inferred crude rates by applying year-specific, age-specific and sex-specific incidence to UK census mid-year population estimates. Results From 1998 to 2017 AF incidence (standardised by age and sex) increased by 30% (from 247 to 322 per 100,000 person-years; adjusted incidence ratio [IRR] 1.30, 95% CI 1.27–1.33) (Figure 1). Absolute number of incident AF increased by 72% (from 117,880 in 1998 to 202,333 in 2017), due to an increasing number of older people. Comorbidity burden at diagnosis of AF increased (2.58 [SD 1.83] vs 3.74 [2.29] conditions; adjusted difference 1.26, 95% CI 1.14–1.39). Age-standardised incidence was higher in men than women (IRR 1.49; 95% CI 1.46–1.52), and men were younger at diagnosis (adjusted difference 5.53 years; 95% CI 5.36–5.69). Socioeconomically deprived individuals had more comorbidities and were more likely to develop AF than the most affluent individuals (IRR 1.20; 95% CI 1.15–1.24). Over time, the age of AF diagnosis declined disproportionately in the most deprived individuals (Figure 2). Conclusion In England AF incidence has increased, and the socioeconomic gradient in age at diagnosis and comorbidity burden widened. This changing burden of AF requires policy-based interventions to prevent associated morbidity and mortality. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): British Heart Foundation, National Institute of Health Research

Nationwide projections of ischemic stroke with large vessel occlusion of the anterior circulation by 2050: Dijon Stroke Registry

“…We chose this option because of specific causes of IS with LVO, i.e., a great frequency of cardioembolic source, especially atrial fibrillation (6). A review of population-and hospital-based studies showed that the recent decline in IS incidence was mostly driven by a decrease in lacunar stroke, whereas cardioembolic IS had increased by 2.4%/year (25), mainly because of a rise in the incidence of atrial fibrillation (26,27). Therefore, we also proposed a model with no decrease in incidence in the age group under 65 years old, with data showing unchanged incidence in this age group since the beginning of the 21st century (17).…”