Temporal trends and patterns in atrial fibrillation incidence: A population-based study of 3·4 million individuals

Abstract

Background: Population-based studies of atrial fibrillation (AF) incidence are needed to inform health-service planning, but evidence is conflicting. We assessed trends of AF incidence in a large general population cohort from England.

Methods: We used linked primary and secondary electronic health records of 3.4 million individuals. Eligible patients aged 16 years and older contributed data between Jan 2 1998 and Dec 31 2017. For patients with incident AF, we extracted baseline characteristics, comorbidities, socioeconomic status and geographic region. We calculated standardised rates by applying direct age and sex standardisation to the 2013 European Standard Population. We applied year-specific, age-specific and sex-specific incidence to UK census mid-year population estimates for yearly total incident AF.

Findings: Comparing 2017 to 1998 standardised AF incidence increased by 30% (322 vs. 247 per 100 000 person-years; adjusted incidence ratio [IRR] 1·30, 95% CI 1·27-1·33). Absolute number of incident AF increased by 72% (202 333 vs. 117 880), due to an increasing number of older persons. Comorbidity burden at diagnosis of AF increased (3·74 [SD 2·29] vs 2·58 [1·83]; adjusted difference 1·26, 95% CI 1·14-1·39). The age of AF diagnosis declined in the most deprived individuals compared to the most affluent (adjusted difference 0·74 years, 0·62-0·88). Across the study period, age-standardised incidence was higher in men than women (IRR 1·49; 95% CI 1·46-1·52), and men were younger at diagnosis (adjusted difference 5·53 years; 95% CI 5·36 to 5·69). Socioeconomically deprived individuals had more comorbidities and a higher incidence of AF than the most affluent individuals (IRR 1·20; 95% CI 1·15-1·24).

Interpretation: In England AF incidence has increased, and the socioeconomic gradient in age at diagnosis and comorbidity burden widened. This changing burden requires policy-based interventions to achieve health equity.

Funding: British Heart Foundation and National Institute for Health Research.

Keywords: Atrial fibrillation; Electronic health records; Incidence; Multimorbidity.

Figure 1

Overall and age-stratified atrial fibrillation incidence in 1998, 2008 and 2017. (A) Number of cases of incident atrial fibrillation per 100 000 people in the European Standard Population. (B) Estimated absolute number of cases of incident atrial fibrillation in the UK population (based on census mid-year estimates).

Figure 2

Atrial fibrillation incidence, by age-group and year of diagnosis. (A) Atrial fibrillation incidence per 1000 person years. (B) Standardised atrial fibrillation incidence per 100,000 persons using European Standard Population.

Figure 3

Temporal trends in comorbidities among patients diagnosed with incident atrial fibrillation, from 1998–2017. (A) Number of comorbidities, out of 18 major conditions, affecting patients with incident atrial fibrillation, over time. (B) Cumulative percentage of patients affected by individual comorbidities over time. COPD = chronic obstructive pulmonary disease; TIA = transient ischaemic attack.

Figure 4

Overall and age-stratified atrial fibrillation incidence for women and men. Standardised atrial fibrillation (AF) incidence (A) presents cases in 100,000 persons from the European standard population. Crude incidence (B) presents estimated absolute number of cases in the United Kingdom (UK) population (2017 census mid-year estimates). Incidence rates were calculated overall years from 1998 to 2017.