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. 2022 Nov;9(2):e002140.
doi: 10.1136/openhrt-2022-002140.

Comprehensive nationwide incidence and prevalence trends of atrial fibrillation in Finland

Mika Lehto  1   2 , Jari Haukka  3 , Aapo Aro  2 , Olli Halminen  4 , Jukka Putaala  5 , Miika Linna  4   6 , Pirjo Mustonen  7 , Janne Kinnunen  5 , Elis Kouki  8 , Jussi Niiranen  2   9 , Alex Luojus  2 , Paula Tiili  5 , Saga Itäinen-Strömberg  2 , Juha Hartikainen  10 , Juhani K E Airaksinen  7 ; FinACAF study group
Affiliations

Comprehensive nationwide incidence and prevalence trends of atrial fibrillation in Finland

Mika Lehto et al. Open Heart. 2022 Nov.

Abstract

Objective: Atrial fibrillation (AF) is a worldwide healthcare challenge owing to population ageing. In this study, we assessed the current trends in the incidence and prevalence of AF for the first time in an unselected, nationwide population.

Methods: In the Finnish Anticoagulation in Atrial Fibrillation study, we gathered comprehensive data including all primary, secondary and tertiary healthcare visits and drug reimbursement from national healthcare registers to identify all patients with incident AF between 2004 and 2018 in Finland. Incident AF was defined as new-onset AF occurring after 2007. Time trends for the incidence and prevalence of AF were calculated and stratified by sex and age.

Results: A total of 411 387 patients with AF diagnosis were documented in Finland during 2004-2018. In 2018, the incidence and prevalence of AF in the total Finnish population were 469/100 000 and 4.1%, respectively. The incidence of new-onset AF in the adult population (≥20 years) increased from 471/100 000 in 2007 to 604/100 000 in 2018, but the age-adjusted incidence remained stable. The prevalence of AF increased in the adult population from 2.5% to 5.2%, and was higher in men than in women (5.9% vs 4.6%, p<0.001). The incidence and prevalence of AF increased with age and were 3194/100 000 and 23.4% in patients older than 75 years.

Conclusions: Based on comprehensive nationwide data including primary care, we observed an increasing incidence and prevalence of AF over time. This increase was strongly age-dependent with the age-standardised incidence remaining stable during 2007-2018.

Trial registration number: NCT04645537.

Keywords: Atrial Fibrillation; Epidemiology; Health Care Economics and Organizations.

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Conflict of interest statement

Competing interests: MLe: Consultant: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim and MSD; Speaker: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim, MSD, Terve Media and Orion Pharma. Research grants: Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund, Boehringer-Ingelheim. JHau: Consultant: Research Janssen R&D; Speaker: Bayer Finland. AA: Research grants: Finnish Foundation for Cardiovascular Research; Speaker: Abbott, Johnson&Johnson, Sanofi, Bayer, Boehringer Ingelheim. JP: Consultant: Boehringer-Ingelheim, Bayer, BMS-Pfizer, Abbott/St. Jude Medical, Vital Signum, Nokia Technologies, Bittium, BcB Medical, Herantis Pharma, Medixine, and Portola. Speaker: Boehringer-Ingelheim, Bayer, BMS-Pfizer, and Terve Media; Research grants: BMS-Pfizer, Abbott/St. Jude Medical, Business Finland, and Amgen. MLi: Speaker: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim. PM: Consultant: Roche, BMS-Pfizer-alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland. JHar: Research grants: The Finnish Foundation for Cardiovascular Research, Advisory Board Member: BMS-Pfizer-alliance, Novo Nordisk, Amgen. Speaker: Cardiome, Bayer. JKEA: Research grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer and Boehringer-Ingelheim. Member in the advisory boards:Bayer, Pfizer and AstraZeneca.

Figures

Figure 1
Figure 1
Frequencies of new-onset atrial fibrillation diagnosis by data source by year. Sources: hospitalisation: care register of Healthcare of hospitalisation and hospital outpatient care (HILMO), primary healthcare: (AvoHILMO) and reimbursement: national reimbursement register of prescriptions (Kela).
Figure 2
Figure 2
The incidence of atrial fibrillation in men and women in relation to age in 2018.
Figure 3
Figure 3
Raw (A) and age-standardised (B) incidence of atrial fibrillation in the adult population (≥20 years) during 2007–2018. Temporary increase in AF incidence in 2011–2013 occurred predominantly in the age group ≥75 years, likely caused by the introduction of the primary care register (AvoHILMO) uncovering older patients with AF treated only in primary care. Grey zone=95% CI.
Figure 4
Figure 4
Incidence rate ratios (IRR) of new-onset atrial fibrillation during 2007–2018 comparing the relative changes within the selected age groups in the adult population (≥20 years) in men (upper panel) and women (lower panel). The analysis is based on Poisson regression model with age, sex, calendar year, hospital district, together with interaction term between year and sex and year and age. Grey zone=95% CI. The horizontal long-dashed line=reference line, that is, 1.0.
Figure 5
Figure 5
Time trends in the prevalence of atrial fibrillation in men and women in the adult population (≥20 years) of Finland.
Figure 6
Figure 6
The prevalence of atrial fibrillation in relation to age in 2018 in men and women.
See this image and copyright information in PMC

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