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. 2021 Aug:7:100157.
doi: 10.1016/j.lanepe.2021.100157.

Atrial fibrillation epidemiology, disparity and healthcare contacts: a population-wide study of 5.6 million individuals

Sheng-Chia Chung  1 , Reecha Sofat  1 , Dionisio Acosta-Mena  2 , Julie A Taylor  1 , Pier D Lambiase  3 , Juan P Casas  4 , Rui Providencia  3
Affiliations

Atrial fibrillation epidemiology, disparity and healthcare contacts: a population-wide study of 5.6 million individuals

Sheng-Chia Chung et al. Lancet Reg Health Eur. 2021 Aug.

Abstract

Background: We aimed to evaluate atrial fibrillation occurrence, reasons for healthcare visits, mortality, causes of death and examined patterns by relative deprivation in the UK. Methods: To study the atrial fibrillation (AF) incidence, mortality and case-fatality, we implemented a prospective cohort study with the linked electronic health records of 5.6 million population in the United Kingdom Clinical Practice Research Datalink from 1998 to 2016. A matched case-control study was used to investigate causes of hospitalisation and death comparing individuals with and without incident AF. Results: During a median follow-up of 10.3 years, 199,433(3.6%) patients developed incident AF. Increased risk of hospitalisation for heart failure, cardiovascular conditions and infection was present among patients who later developed AF. Following an AF diagnosis, patients were frequently admitted to the hospital for heart failure, lower respiratory tract infection, chronic obstructive pulmonary disease and ischemic heart disease. One in 5 AF patients died during the first year after diagnosis, and the mortality increased to 42.7% at the fifth year. The excess deaths in AF cases compared to controls may result from cardiovascular diseases, infection and metabolic disorders. Individuals from areas with higher deprivation in socioeconomic and living status had both higher AF incidence and fatality. Interpretation: We observed an elevated risk of hospitalisation for cardiovascular or respiratory diseases among incident AF patients, and the considerable disparity in AF burden by socioeconomic deprivation informs priorities for prevention and provision of patient care. Funding: The study was supported by the GlaxoSmithKline, University College London Hospital and National Institute for Health Research. The funders did not have any role in study design, data collection, data analysis, interpretation, and writing of the report.

Keywords: Atrial Fibrillation; Electronic Health Records; cause of death; epidemiology; health inequality; healthcare contacts.

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Conflict of interest statement

SCC and DA report supported by funding from GlaxoSmithKline for electronic health records research, and the funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Other authors declare no conflict of interest.

Figures

Figure 1:
Fig. 1
Flow chart of the study population.
Figure 2:
Fig. 2
Atrial fibrillation incidence and estimated deaths among incident cases by age groups in men and women
Figure 3:
Fig. 3
Atrial fibrillation incidence and fatality by socioeconomical status
Figure 4:
Fig. 4
Top 10 reasons for hospitalisation in atrial fibrillation patients, compared to controls, within 5 years pre and post incident AF diagnosis.
Figure 5
Fig. 5
Mortality rate in incident atrial fibrillation cases and their matched controls.
Figure 6:
Fig. 6
Leading primary cause of death in AF patients and in age and sex matched control
See this image and copyright information in PMC

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