Prospective National Study of the Prevalence, Incidence, Management and Outcome of a Large Contemporary Cohort of Patients With Incident Non‐Valvular Atrial Fibrillation

Abstract

BackgroundThere are few studies of atrial fibrillation (AF) outside of North America or Europe. The aim of the present study was to assess the prevalence, incidence, management and outcomes of patients with new atrial fibrillation, in a large contemporary cohort (2004–2012) of adult patients.Methods and ResultsThe Clalit Health Services (CHS) computerized database of 2 420 000 adults, includes data of community clinic visits, hospital discharge records, medical diagnoses, medications, medical interventions, and laboratory test results. The prevalence of AF on January 1, 2004 was 71 644 (3%). Prevalence and incidence of AF increased with age and was higher in men versus women. During the study period (2004–2012) 98 811 patients developed new non‐valvular AF (mean age −72, 50% women, 46% with cardiovascular disease, 6% with prior stroke). The rate of persistent warfarin use (dispensed for >3 months in a calendar year) was low (25.7%) and it increased with increasing stroke risk score. Individual Time in Therapeutic Range (TTR) among warfarin users was 42%. The incidence rate of ischemic stroke and death increased with age. The rate of stroke increased from 2 per 1000 person years in patients with CHA2DS2_VASC SCORE of 0, to 58 per 1000 person years in those with a score of 9.ConclusionsIn the present study the prevalence and incidence of AF, stroke, and death were comparable to those reported in Europe and North America. The low use of anticoagulation calls for measures to increase adherence to current treatment recommendations in order to improve outcomes.

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…3 -5 By 2030, 14 -17 million AF patients are anticipated in the European Union, with 120 000-215 000 newly diagnosed patients per year. 2,6,7 Estimates suggest an AF prevalence of approximately 3% in adults aged 20 years or older, 8,9 with greater prevalence in older persons 1 and in patients with conditions such as hypertension, heart failure, coronary artery disease (CAD), valvular heart disease, obesity, diabetes mellitus, or chronic kidney disease (CKD). 7,10 -15 The increase in AF prevalence can be attributed both to better detection of silent AF 16 -18 , alongside increasing age and conditions predisposing to AF.…”

“…360, 361 The bleeding risk on aspirin is not different to the bleeding risk on VKA 362 or NOAC therapy, 354,363 while VKA and NOACs, but not aspirin, effectively prevent strokes in AF patients. 38,354,362,363 9.1 Prediction of stroke and bleeding risk 9.1.1 Clinical risk scores for stroke and systemic embolism Simple, clinically applicable stroke risk-stratification schemes in AF patients were developed in the late 1990s in small cohort studies, and have later been refined and validated in larger populations. 364 -368 The introduction of the CHA 2 DS 2 -VASc score (Table 11) has simplified the initial decision for OAC in AF patients.…”

“…502 OAC interruptions should be minimized to prevent stroke. 9.6 Management of bleeding events in anticoagulated patients with atrial fibrillation 9.6.1 Management of minor, moderate, and severe bleeding General assessment of an anticoagulated patient with AF experiencing a bleeding event should include the assessment of bleeding site, onset, and severity of the bleeding, the time-point of last intake of OAC and other antithrombotic drugs, and other factors influencing bleeding risk such as CKD, alcohol abuse, and concurrent medications. Laboratory tests should include haemoglobin, haematocrit, platelet count, renal function, and, for VKA patients, prothrombin time, activated partial thromboplastin time, and INR.…”

Epidemiologic Aspects of Atrial Fibrillation in a Tertiary Hospital in a Sub-Saharan Africa Setting

“…This is due to the rapid urbanization that is associated with changes in life-style, which leads to the emergence of CVD risk such as hypertension, diabetes, dyslipidemia, obesity, tobacco use, and sedentarity [1] [2]. Atrial fibrillation (AF) is the most frequent sustained arrhythmia affecting 3% of the adult population [3] [4]. It carries a high morbidity and mortality due to its complications such as ischemic stroke, heart failure, and sudden death [5] [6] [7].…”

Soluble ST2 in Patients with Nonvalvular Atrial Fibrillation and Prediction of Heart Failure

“…Among 98,811 patients with incident new AF, 22.0% had HF. 21) Over one-third of patients with AF also experienced HF events. 22) The presence of both AF and HF portended a higher mortality risk than either condition alone.…”