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Comparative Study
. 2012 Nov 6;126(19):2293-301.
doi: 10.1161/CIRCULATIONAHA.112.099606. Epub 2012 Oct 2.

Trends in the incidence of atrial fibrillation in older patients initiating dialysis in the United States

Benjamin A Goldstein  1 , Cristina M Arce, Mark A Hlatky, Mintu Turakhia, Soko Setoguchi, Wolfgang C Winkelmayer
Affiliations
Comparative Study

Trends in the incidence of atrial fibrillation in older patients initiating dialysis in the United States

Benjamin A Goldstein et al. Circulation. .

Abstract

Background: One sixth of US dialysis patients 65 years of age have been diagnosed with atrial fibrillation/flutter (AF). Little is known, however, about the incidence of AF in this population.

Methods and results: We identified 258 605 older patients (≥67 years of age) with fee-for-service Medicare initiating dialysis in 1995 to 2007, who had not been diagnosed with AF within the previous 2 years. Patients were followed for newly diagnosed AF. Multivariable proportional hazard regression was used to examine temporal trends and associations of race and ethnicity with incident AF. We also studied temporal trends in the mortality and risk of ischemic stroke after new AF. Over 514 395 person-years of follow-up, 76 252 patients experienced incident AF for a crude AF incidence rate of 148/1000 person-years. Incidence of AF increased by 11% (95% confidence interval, 5-16) from 1995 to 2007. Compared with non-Hispanic whites, blacks (-30%), Asians (-19%), Native Americans (-42%), and Hispanics (-29%) all had lower rates of incident AF. Mortality after incident AF decreased by 22% from 1995 to 2008. Even more pronounced reductions were seen for incident ischemic stroke during these years.

Conclusions: The incidence of AF is high in older patients initiating dialysis in the United States and has been increasing over the 13 years of study. Mortality declined during that time but remained >50% during the first year after newly diagnosed AF. Because data on warfarin use were not available, we were unable to study whether trends toward better outcomes could be explained by higher rates of oral anticoagulation.

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Figures

Figure 1
Figure 1
Flow Diagram of Cohort Selection
Figure 2
Figure 2
Trends in the 1-year Probabilities of Atrial Fibrillation after Initiation of Dialysis
Figure 2
Figure 2
Trends in the 1-year Probabilities of Atrial Fibrillation after Initiation of Dialysis
Figure 2
Figure 2
Trends in the 1-year Probabilities of Atrial Fibrillation after Initiation of Dialysis
Figure 3
Figure 3. Relative Annual Incidences of Atrial Fibrillation over Time
Note: Comorbidity-adjusted model includes demographics (age at ESRD, sex, race, Hispanic ethnicity), as well as indicator variables for diagnosed hypertension, atherosclerotic heart disease, heart failure, cerebrovascular disease, peripheral vascular disease, diabetes, pulmonary disease, cancer, smoking, drug abuse, alcohol abuse, immobility (inability to ambulate or transfer), dialysis modality, use of an erythropoiesis-stimulating agent prior to initiation of dialysis, body mass index.
Figure 4
Figure 4
Relative Annual Mortality Hazards after Incident Atrial Fibrillation over Time
See this image and copyright information in PMC

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