The Danish Atrial Fibrillation Registry: A Multidisciplinary National Pragmatic Initiative for Monitoring and Supporting Quality of Care Based on Data Retrieved from Administrative Registries

Abstract

The Danish Atrial Fibrillation (AF) Registry monitors and supports improvement of quality of care for all AF patients in Denmark. This report describes the registry's administrative and organizational structure, data sources, data flow, data analyses, annual reporting, and feedback between the registry, clinicians, and the administrative system. We also report the selection process of the quality indicators and the temporal trends in results from 2017-2021. Methods and Results:The Danish AF Registry aims for complete registration and monitoring of care for all patients diagnosed with AF in Denmark. Administrative registries provide data on contacts to general practice, contacts to private cardiology practice, hospital contacts, medication prescriptions, updated vital status information, and biochemical test results. The Danish Stroke Registry provides information on stroke events. From 2017 to 2021, the proportion with a reported echocardiography among incident AF patients increased from 39.9% (95% CI: 39.3-40.6) to 82.6% (95% CI: 82.1-83.1). The initiation of oral anticoagulant therapy among patients with incident AF and a CHA 2 DS 2 -VASc score of ≥1 in men and ≥2 in women increased from 85.3% (95% CI: 84.6-85.9) to 90.4% (95% CI: 89.9-91.0). The 1-year and 2-year persistence increased from 85.2% (95% CI: 84.5-85.9) to 88.7% (95% CI: 88.0-89.3), and from 85.4% (95% CI: 84.7-86.2) to 88.2% (95% CI: 87.5-88.8), respectively. The 1-year risk of ischemic stroke among prevalent patients with AF decreased from 0.88% (95% CI: 0.83-0.93) to 0.71% (95% CI: 0.66-0.75). Variation in clinical performance between the five administrative Danish regions was reduced. Conclusion: Continuous nationwide monitoring of quality indicators for AF originating from administrative registries is feasible and supportive of improvements of quality of care.

Temporal trends in lifetime risks of atrial fibrillation and its complications between 2000 and 2022: Danish, nationwide, population based cohort study

“…Estimates of the lifetime risk of complications after atrial fibrillation indicate the burden of the different complications, and such information may be essential to facilitate prioritisation and development of preventive efforts against complications, prediction of complications, and management of health policy. In Denmark, more than 85% of patients with atrial fibrillation initiate oral anticoagulation, and the one year and two year persistence are both above 85% 38. Despite a high rate of anticoagulation treatment, we observed that stroke risk remains a very important problem after atrial fibrillation.…”

“…In Denmark, more than 85% of patients with atrial fibrillation initiate oral anticoagulation, and the one year and two year persistence are both above 85%. 38 Despite a high rate of anticoagulation treatment, we observed that stroke risk remains a very important problem after atrial fibrillation. These findings underscore the need for treatments to further decrease stroke risk.…”

“…We had no specific data for the proportion of patients with incident atrial fibrillation who were not captured by the Danish National Patient Registry. However, as the Danish guidelines recommend referral of patients with newly diagnosed atrial fibrillation to a public hospital for further examination, most patients with atrial fibrillation will be registered, and only a few cardiologists work outside of the public healthcare system in Denmark 38. In Sweden, where the healthcare system is very similar to the Danish system, a study using data from 2004 to 2010 from the Swedish National Patient Registry and a central electrocardiogram database found that 93.2% of patients with electrocardiogram confirmed atrial fibrillation had a recording in the Swedish National Patient Registry 39.…”

“…However, as the Danish guidelines recommend referral of patients with newly diagnosed atrial fibrillation to a public hospital for further examination, most patients with atrial fibrillation will be registered, and only a few cardiologists work outside of the public healthcare system in Denmark. 38 In Sweden, where the healthcare system is very similar to the Danish system, a study using data from 2004 to 2010 from the Swedish National Patient Registry and a central electrocardiogram database found that 93.2% of patients with electrocardiogram confirmed atrial fibrillation had a recording in the Swedish National Patient Registry. 39 Additionally, validation studies reported a high positive predictive value of atrial fibrillation and atrial flutter in the Danish National Patient Registry.…”