Decade-long trends in atrial fibrillation incidence and survival: a community study

Abstract

Background: Contemporary data on temporal trends in incidence and survival after atrial fibrillation are scarce.

Methods: Residents of Olmsted County, Minn., with a first-ever atrial fibrillation or atrial flutter event between 2000 and 2010 were identified. Age- and sex-adjusted incidence rates were standardized to the 2010 US population, and the relative risk of atrial fibrillation in 2010 versus 2000 was calculated using Poisson regression. Standardized mortality ratios of observed versus expected survival were calculated, and time trends in survival were examined using Cox regression.

Results: We identified 3344 patients with incident atrial fibrillation/atrial flutter events (52% were male, mean age 72.6 years, 95.7% were white). Incidence did not change over time (age- and sex-adjusted rate ratio, 1.01; 95% confidence interval [CI], 0.91-1.13 for 2010 vs 2000). Within the first 90 days, the risk of all-cause mortality was greatly elevated compared with individuals of a similar age and sex distribution in the general population (standardized mortality ratios 19.4 [95% CI, 17.3-21.7] and 4.2 [95% CI, 3.5-5.0] for the first 30 days and 31 to 90 days after diagnosis, respectively). Survival within the first 90 days did not improve over the study period (adjusted hazard ratio, 0.96; 95% CI, 0.71-1.32 for 2010 vs 2000); likewise, no difference in mortality between 2010 and 2000 was observed among 90-day survivors (hazard ratio, 1.05; 95% CI, 0.85-1.31).

Conclusions: In the community, atrial fibrillation incidence and survival have remained constant over the last decade. A dramatic and persistent excess risk of death was observed in the 90 days after atrial fibrillation diagnosis, underscoring the importance of early risk stratification.

Keywords: Atrial fibrillation; Epidemiology; Incidence; Survival.

Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to disclose.

Copyright © 2015 Elsevier Inc. All rights reserved.

Figures

Figure 1

Identification and validation of incident atrial fibrillation in Olmsted County, Minnesota between 2000 and 2010.

Figure 2

Incidence of atrial fibrillation by age and sex strata in Olmsted County, Minnesota between 2000 and 2010.

Figure 3

Standardized mortality ratios by age group after incident atrial fibrillation Shaded area indicates 95% confidence intervals.

Figure 4

Predictors of death within 90 days after diagnosis of atrial fibrillation Hazard ratios are adjusted for year of atrial fibrillation diagnosis, age, sex, and all other variables presented. HR, hazard ratio; CI, confidence interval; PAF, population attributable fraction