Age-specific incidence, outcome, cost, and projected future burden of atrial fibrillation-related embolic vascular events: a population-based study

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.

Keywords: atrial fibrillation; atrial flutter; embolism; population; stroke.

Figure 1

Age- and sex-specific rates per 100,000 population per year in OXVASC for all incident AF-related ischaemic stroke and systemic embolism combined (A) and separately (B).

Figure 2

Age-specific rates (per 100,000 population per year) of incident AF-related ischaemic stroke in OCSP (1981-1986) and OXVASC (2002-2012). Error bars signify the upper 95% confidence interval.

Figure 3

Projected number of AF-related incident ischaemic strokes (dark gray bar) and incident systemic emboli (light gray bar) extrapolated from OXVASC to the UK population in 2010, 2030 and 2050 stratified by age and based on the current incidence rate in OXVASC.