The incidence of atrial fibrillation (AF) increased from 2000 to 2018 in patients <65 years of age. Oral anticoagulation (OAC), electrical cardioversion, and catheter ablation increased the cumulative incidence in the first year after initial AF diagnosis, according to the results of a study published in . International Cardiology Journal.
The researchers investigated the incidence of atrial fibrillation, treatment approaches, and atrial fibrillation rehospitalization (primary or secondary diagnosis of hospitalized patients or emergency room visits after the first atrial fibrillation visit) in patients younger than 65 years. We sought to investigate changes in rates over time.
They conducted a retrospective cohort study using the Danish National Registry and data from 2000 to 2018 to identify 60,917 patients aged 18 to 65 years who were initially diagnosed with atrial fibrillation. Patients were classified according to the following calendar periods:
- 2000-2002. n=8150 (13.4%)
- 2003-2006. n=11,898 (19.5%)
- 2007-2010. n=13,560 (22.3%)
- 2011-2014. n=14,167 (23.3%)
- 2015-2018. n=13,142 (21.5%)
All five calendar periods had similar burdens by comorbidity, age, and gender distribution. Over the calendar period, 73.2% of patients were hospitalized with AF as a primary diagnosis and 26.8% of patients were hospitalized with AF as a secondary diagnosis.
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A national cohort from 2000 to 2018 that examined patients younger than 65 years found an increase in the incidence of atrial fibrillation over calendar time.
Patients previously diagnosed with AF. Persons who filled out a prescription for OAC within 6 months prior to diagnosis of AF. Prescribing dronedarone, amiodarone, digoxin, or flecainide prior to diagnosis of AF. Those who have previously undergone catheter ablation for atrial fibrillation. Individuals with congenital heart disease or mitral stenosis were excluded.
Over the following calendar periods, the crude incidence of atrial fibrillation increased stepwise.
- 2000–2002 (78.7 per 100,000 person-years, 95% CI, 77.0–80.4)
- 2003–2006 (86.3 per 100,000 person-years, 95% CI, 84.7–87.8)
- 2007–2010 (97.9 per 100,000 person-years, 95% CI, 96.3–99.6)
- 2011–2014 (102.3 per 100,000 person-years, 95% CI, 100.7–104.0)
No increase was observed from 2015 to 2018 (93.6 per 100,000 person-years, 95% CI, 92.0–95.2).
From 2000 to 2002 (28.5%) and from 2015 to 2018 (47.8%), the cumulative incidence of OAC treatment within 3 months after AF diagnosis increased stepwise. P.on trend ≤.0001). Among patients treated with OAC, 44.8% had a CHA2DS2-VASc score of 0, 20.2% had a score of 1, and 35.0% had a score of 1 or higher.
The incidence of OAC treatment within 3 months before and after ablation increased from 2000 to 2002 (54.3%) and from 2015 to 2018 (95.5%). P.on trend≤.0001).
The cumulative incidence of cardioversion increased stepwise from 2000 to 2002 (2.0%) and from 2015 to 2018 (8.7%). P. <.0001). Also, the cumulative incidence of catheter ablation within 1 year of atrial fibrillation diagnosis increased stepwise from 2000 to 2002 (1.2%) and from 2015 to 2018 (7.6%). P. <.0001). Of all patients undergoing catheter ablation (n = 2562), 15.1% were diagnosed with heart failure (HF) within her 2 years before catheter ablation. After 1 year, her incidence of AF readmission did not differ by time.
Study limitations include lack of data on important clinical factors, type and duration of atrial fibrillation.
“In a national cohort from 2000 to 2018 that examined patients younger than 65 years, we found an increase in the incidence of atrial fibrillation over calendar time,” the study authors wrote. “Use of catheter ablation, electrical cardioversion, and OAC therapy increased throughout the study period.”
Disclosure: Some study authors have declared affiliations with biotechnology, pharmaceutical, and/or device companies. See the original references for a complete list of author disclosures.