Diagnosed, undiagnosed and overall atrial fibrillation research on population over 60 year-old. AFABE study

Abstract

Background: Undiagnosed atrial fibrillation usually is only detected with the first complication. We estimated undiagnosed Atrial Fibrillation prevalence, overall AF and associated factors in a public health-service area in Catalonia, north-eastern Spain. Methods: Multicentre, cross-sectional study, with people randomly selected among the attended population over 60 years old by primary care teams regardless of follow-up time in health centres or at homes. Information was collected through ECGs, electronic medical history reviews and medical interviews. Descriptive and logistic regression analysis was performed. Results: 1043 subjects were recruited (47.1% male), mean age: 73.1 y-o (SD: 7.8 y-o); 43.3% ≥75-year-old. Overall AF prevalence was 10.9% (CI95% 9.1-12.8%); higher in men than in women, progressively increasing with age (24.4% in ≥85-year-old). Only women ≥85-year-old had higher prevalence (26.2%) than men (22.5%). Undiagnosed AF relative prevalence was 2.2% (IC95% 1.3-3.1%). These results show that about 1 in 50 people over 60 years old could suffer undiagnosed AF. The higher risk of AF undiagnosed was found in: men (OR 2.5 IC95% 1.0-6.2), >75 years old (OR 2.5 IC95% 1.0-6.1), heart failure history , who live in rural areas (OR 15.9 IC95% 1.5-160.1) and to whom no one ECG was performed in the last two years. Conclusions: The overall AF prevalence increased 10 times from the sixties to over eighties and the proportion man-woman changes from 4:1 to 1:1. The undiagnosed AF prevalence was 2.2% (IC95% 1.3-3.1). This percentage should be added to the one of untreated cases with OAC.

Results from the Registry of Atrial Fibrillation (AFABE): Gap between Undiagnosed and Registered Atrial Fibrillation in Adults—Ineffectiveness of Oral Anticoagulation Treatment with VKA

“…The AFABE [ 8 , 13 ] study is a cross-sectional, multicentre study of undiagnosed AF among out-of-hospital patients over 60 years old attending primary care teams in the Terres de l'Ebre health area in Catalonia, north-eastern Spain, on 31 July 2014. The patients in the sample were registered with health centres and were visited there or at home for AF diagnosis according to the routine ICD-10 classification used in the primary care dataset for a revision of the electronic medical history.…”

“…The registered AF prevalence included people who were a case with a diagnosed and registered AF in their public health primary care electronic medical history according to the ICD-10 routine classification used in the primary care dataset for a revision of the electronic medical history. Based on the census of 2011, the expected AF prevalence was calculated using the data obtained in the AFABE study [ 8 , 13 ]. The AFABE (Baix Ebre) study was a sample of the current population ( Figure 1 ).…”

“…Due to the associated increased morbidity, mortality, and cost, challenges in the identification of patients at risk for thromboembolic events from AF must be addressed. AF is often only detected with the onset of severe AF-related complications such as stroke or heart failure [ 8 , 9 ]. Although national guidelines recommend the use of oral anticoagulation (OAC) medication for stroke prevention and there is clear evidence of the effectiveness of vitamin K antagonist (VKA) therapy in patients with AF [ 10 ], the literature consistently reports its underuse in AF patients with moderate to high stroke risk [ 1 , 11 ].…”

“…The aim of the study is to document the quality of anticoagulant control in primary care, considering the potential impact of undiagnosed AF, the underutilization of VKAs, and results related to TTR. The challenges include compliance with performance measures, adherence to guidelines, adequate prevention, and early control of comorbidities that affect the progression of AF and associated risks, early initiation of treatment, and successful evaluation of the associated risks of bleeding, primary or recurrent stroke, and patient awareness and compliance [ 1 , 8 , 13 ].…”