Temporal Trends in Incidence, Prevalence, and Mortality of Atrial Fibrillation in Primary Care

Abstract

Background: Incidence and prevalence of atrial fibrillation (AF) are expected to increase dramatically; however, we currently lack comprehensive data on temporal trends in unselected clinical populations.

Methods and results: Analysis of the UK Clinical Practice Research Datalink (CPRD) from 1998 to 2010 of patients with incident AF, excluding major valvular disease, linked to hospital admission data and national statistics. Fifty-seven thousand eight hundred eighteen adults were identified with mean age 74.2 (SD, 11.7) years and 48.3% women. Overall age-adjusted incidence of AF per 1000 person years was 1.11 (95% CI, 1.09-1.13) in 1998-2001, 1.33 (1.31-1.34) in 2002-2006, and 1.33 (1.31-1.35) in 2007-2010. Ongoing increases in incidence were noted for patients aged ≥75 years, with similar temporal patterns in women and men. Associated comorbidities varied over time, with a constant prevalence of previous stroke, increases in hypertension and diabetes mellitus, and decreases in ischemic heart disease. Among patients aged 55 to 74 years, there was a significant reduction in mortality over time (P<0.001), but mortality rates in patients aged ≥75 years remained static at 14% to 15% per year (P=0.84). Projections of AF prevalence demonstrated a constant yearly rise, increasing from 700 000 patients in 2010 to between 1.3 and 1.8 million patients with AF in the United Kingdom by 2060.

Conclusions: In a large general practice population, incident AF increased and then plateaued overall, with a continued increase in patients aged ≥75 years. The large projected increase in AF prevalence associated with temporal changes in AF-related comorbidities suggests the need for comprehensive implementation of AF prevention and management strategies.

Keywords: atrial fibrillation; epidemiology; incidence; mortality; prevalence; primary care.

Figure 1

Age‐adjusted annual incidence rate of atrial fibrillation per 1000 in the UK (1998–2010) showing (A) increases in incidence over time with increasing age, particularly in older patients, and (B) sex‐stratified incidence of atrial fibrillation with higher rates in men.

Figure 2

One‐year crude mortality rates and 95% CIs according to the year of incident atrial fibrillation. In patients aged 55 to 74 years, there was a significant reduction over time (incidence rate ratio per calendar year, 0.97; 95% CI, 0.95–0.99; P<0.001), whereas no difference in mortality was observed in patients aged ≥75 years (incidence rate ratio, 1.00; 95% CI, 0.99–1.01; P=0.84).

Figure 3

Estimated change from 2010 in the UK population and numbers of patients with AF in comparison to the predicted United Kingdom population, assuming increased incidence of AF. AF indicates atrial fibrillation.