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. 2023 Sep 28:10:1204892.
doi: 10.3389/fcvm.2023.1204892. eCollection 2023.

Electronic health record-wide association study for atrial fibrillation in a British cohort

Sheng-Chia Chung  1 , Amand F Schmit  2 , Gregory Y H Lip  3   4 , Rui Providencia  1   5
Affiliations

Electronic health record-wide association study for atrial fibrillation in a British cohort

Sheng-Chia Chung et al. Front Cardiovasc Med. .

Abstract

Background: Atrial fibrillation (AF) confers a major healthcare burden from hospitalisations and AF-related complications, such as stroke and heart failure. We performed an electronic health records-wide association study to identify the most frequent reasons for healthcare utilization, pre and post new-onset AF.

Methods: Prospective cohort study with the linked electronic health records of 5.6 million patients in the United Kingdom Clinical Practice Research Datalink (1998-2016). A cohort study with AF patients and their age-and sex matched controls was implemented to compare the top 100 reasons of frequent hospitalisation and primary consultation.

Results: Of the 199,433 patients who developed AF, we found the most frequent healthcare interactions to be cardiac, cerebrovascular and peripheral-vascular conditions, both prior to AF diagnosis (41/100 conditions in secondary care, such as cerebral infarction and valve diseases; and 33/100 conditions in primary care), and subsequently (47/100 conditions hospital care and 48 conditions in primary care). There was a high representation of repeated visits for cancer and infection affecting multiple organ systems. We identified 10 novel conditions which have not yet been associated with AF: folic acid deficiency, pancytopenia, idiopathic thrombocytopenic purpura, seborrheic dermatitis, lymphoedema, angioedema, laryngopharyngeal reflux, rib fracture, haemorrhagic gastritis, inflammatory polyneuropathies.

Conclusion: Our nationwide data provide knowledge and better understanding of the clinical needs of AF patients suggesting: (i) groups at higher risk of AF, where screening may be more cost-effective, and (ii) potential complications developing following new-onset AF that can be prevented through implementation of comprehensive integrated care management and more personalised, tailored treatment.

Clinical trial registration: NCT04786366.

Keywords: arrhythmia; clinical visits; electronic health records; hospitalization; population study; primary care.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Top 100 reasons for hospitalisation (2ary care) and GP consultations (1ary care) in atrial fibrillation patients, compared to controls, within 5 years before and in the 5 years after new-onset AF diagnosis. The four iris-plots represent the top reasons (displayed as relative risk vs. controls) for healthcare utilization (primary and secondary care) prior and post new-onset AF. The 14 diagnostic groups are organized by different colours (legend) and clockwise as follows, as per the upper-left iris-plot: bleeding/haemorrhagic (12 h), cancer (1 h to 2 h), cardiac (3–4 h), cerebrovascular (5 h), “endocrine, nutritional or metabolic” & “frailty or multimorbidity” (6 h), gastrointestinal (7 h), haematological and infectious (8 h), osteoarticular & other (9 h), “peripheral other vascular” (10 h), renal (11 h), and respiratory (11–12 h). Different scales were used in the 4 iris-plots to accommodate with the different range of relative risks.
See this image and copyright information in PMC

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