Prevalence of atrial fibrillation in US nursing homes: results from the National Nursing Home Survey, 1985-2004

Abstract

Objectives: To evaluate the prevalence of atrial fibrillation (AFib) in US nursing homes from 1985 to 2004 and to project the prevalence of AFib to 2030.

Design: This study is an analysis of cross-sectional data from the US National Nursing Home Survey, years 1985, 1995, 1997, 1999, and 2004.

Setting: Randomly selected long term care facilities in the United States licensed by the state or certified for Medicaid/Medicare reimbursement.

Participants: Randomly selected residents within study facilities.

Measurements: National Nursing Home Survey demographics and current medical conditions data were analyzed. Population estimates were calculated using National Nursing Home Survey sample weights. Absolute observed annual linear growth of the AFib prevalence rate was calculated using linear regression. Predictive margins were estimated using logistic regression models to evaluate effect of changes in resident case-mix over the survey years. Three estimation methods predicted the number residents having AFib in 2030.

Results: The sample sizes of surveyed resident groups were as follows: n = 5238 (1985); n = 8056 (1995); n = 8138 (1997); n = 8215 (1999); and n = 13,507 (2004). Prevalence rates of AFib by year were 2.8% (95% confidence interval [CI]: 2.3-3.4%; 1985), 5.1% (95% CI: 4.6-5.6%; 1995), 5.8% (95% CI: 5.3-6.3%; 1997), 6.9% (95% CI: 6.3-7.4%; 1999), and 10.9% (95% CI: 10.2-11.5%; 2004). Population estimates of nursing home residents with AFib (in thousands) were 42.2 (95% CI: 34.1-50.3; 1985), 78.7 (95% CI: 70.8-86.7; 1995), 93.6 (95% CI: 84.9-102.3; 1997), 111.8 (95% CI: 102.1-121.5; 1999), and 162.1 (95% CI: 152.4-171.7; 2004). Absolute annual linear growth in the prevalence rate of AFib was +0.38% observed (P = .022), +0.39% using unadjusted predictive margins (P = .007), and +0.37% using adjusted predictive margins (P = .007). Projected estimates showed that 272,000 (95% CI: 197,000-347,000), 300,000, or 325,000 residents would have AFib in the year 2030.

Conclusion: The prevalence of AFib in US nursing home residents increased from 1985 to 2004 and is projected to grow substantially over the next 20 years, potentially resulting in an increased nursing home staff burden owing to increased stroke risk evaluations.