Highlights
- •Incidence of atrial fibrillation/flutter (AF) rose through the study period.
- •Further use of catheter ablation and electrical cardioversion.
- •Higher use of oral anticoagulation medication.
- •Constant rates of AF-readmissions through calendar time.
Abstract
Aim
To examine temporal changes in incidence rates of atrial fibrillation/flutter (AF),
treatment strategies, and AF readmission rates in patients <65 years.
Methods
Using Danish nationwide registries, we identified patients <65 years with a first-time
AF diagnosis from 2000 to 2018. The cohort was categorized according to calendar periods;
2000–2002, 2003–2006, 2007–2010, 2011–2014, and 2015–2018. In this retrospective cohort
study the incidence rate (IR) of AF per 100,000 person years (PY), catheter ablation,
electrical cardioversion, use of pharmacotherapy, and AF readmission, were investigated
in the first year following AF diagnosis.
Results
We identified 60,917 patients; 8150 (13.4%) in 2000–2002, 11,898 (19.5%) in 2003–2006,
13,560 (22.3%) in 2007–2010, 14,167 (23.3%) in 2011–2014, and 13,142 (21.6%) in 2015–2018.
Apart from 2015 to 2018, a stepwise increase in the crude IR of AF was observed across
calendar periods; 2000–2002: 78.7 (95% CI 77.0;80.4), 2003–2006: 86.3 (84.7;87.8),
2007–2010: 97.9 (96.3;99.6), 2011–2014: 102.3 (100.7;104.0), 2015–2018: 93.6 (92.0;95.2).
Over the studied time-periods, we found a stepwise increase in the cumulative incidence
of catheter ablation (1.2% to 7.6%) electrical cardioversion (2.0% to 8.7%) and treatment
with oral anticoagulant therapy (OAC) (28.5% to 47.8%) within the first year of diagnosis.
No temporal differences in incidence of 1-year AF readmission were identified (AF-readmissions:
2000–2002: 32.7%, 2003–2006: 31.1%, 2007–2010: 32.2%, 2011–2014: 32.1% and 2015–2018:
31.7%).
Conclusion
The incidence rate of AF in patients <65 years increased from 2000 to 2018, as did
the use of catheter ablation, electrical cardioversion and OAC in the first year following
AF diagnosis. 1-year AF readmission incidence remained stable around 32% over the
study period.
Graphical abstract
Graphical Abstract
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to International Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association.Circulation. Mar 5 2019; 139 (e56-e528)https://doi.org/10.1161/cir.0000000000000659
- AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Heart Rhythm Society.Circulation. 2014; 130 (e1-76)https://doi.org/10.1161/cir.0000000000000040
- 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European heart rhythm association (EHRA) of the ESC.Eur. Heart J. Feb 1 2021; 42: 373-498https://doi.org/10.1093/eurheartj/ehaa612
- Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and risk factors in atrial fibrillation (ATRIA) study.Jama. May 9 2001; 285: 2370-2375https://doi.org/10.1001/jama.285.18.2370
- Epidemiology of atrial fibrillation: European perspective.Clin Epidemiol. 2014; 6: 213-220https://doi.org/10.2147/CLEP.S47385
- Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications.Arch. Intern. Med. Mar 13 1995; 155: 469-473
- Increased use of oral anticoagulants in patients with atrial fibrillation: temporal trends from 2005 to 2015 in Denmark.Eur. Heart J. Mar 21 2017; 38: 899-906https://doi.org/10.1093/eurheartj/ehw658
- Atrial fibrillation pathophysiology: implications for management.Circulation. Nov 15 2011; 124: 2264-2274https://doi.org/10.1161/CIRCULATIONAHA.111.019893
- Comparison of atrial fibrillation in the young versus that in the elderly: a review.Cardiol. Res. Pract. 2013; 2013976976https://doi.org/10.1155/2013/976976
- The Danish National patient register.Scand. J. Public Health. Jul 2011; 39: 30-33https://doi.org/10.1177/1403494811401482
- The Danish National prescription registry.Scand. J Public Health. Jul 2011; 39: 38-41https://doi.org/10.1177/1403494810394717
- The Danish civil registration system.Scand. J Public Health. Jul 2011; 39: 22-25https://doi.org/10.1177/1403494810387965
- The Danish health care system and epidemiological research: from health care contacts to database records.Clin Epidemiol. 2019; 11: 563-591https://doi.org/10.2147/CLEP.S179083
- Positive predictive value of cardiovascular diagnoses in the Danish National Patient Registry: a validation study.BMJ Open. Nov 18 2016; 6e012832https://doi.org/10.1136/bmjopen-2016-012832
- Validity of the diagnoses atrial fibrillation and atrial flutter in a Danish patient registry.Scand. Cardiovasc. J. Jun 2012; 46: 149-153https://doi.org/10.3109/14017431.2012.673728
- Non-vitamin K antagonist oral anticoagulation agents in anticoagulant naive atrial fibrillation patients: Danish nationwide descriptive data 2011-2013.Europace. Feb 2015; 17: 187-193https://doi.org/10.1093/europace/euu225
- Non-vitamin K antagonist oral anticoagulation usage according to age among patients with atrial fibrillation: temporal trends 2011-2015 in Denmark.Sci. Rep. Aug 11 2016; 6: 31477https://doi.org/10.1038/srep31477
- Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study.BMJ. Jan 31 2011; 342d124https://doi.org/10.1136/bmj.d124
- Trends in atrial fibrillation incidence rates within an integrated health care delivery system, 2006 to 2018.JAMA Netw. Open. Aug 3 2020; 3e2014874https://doi.org/10.1001/jamanetworkopen.2020.14874
- 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham heart study: a cohort study.Lancet. Jul 11 2015; 386: 154-162https://doi.org/10.1016/S0140-6736(14)61774-8
- Trends and predictors of early ablation for Atrial Fibrillation in a Nationwide population under age 65: a retrospective observational study.BMC Cardiovasc. Disord. Apr 6 2020; 20: 161https://doi.org/10.1186/s12872-020-01446-9
- 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation.Heart Rhythm. Oct 2017; 14: e275-e444https://doi.org/10.1016/j.hrthm.2017.05.012
- Trends in catheter ablation for atrial fibrillation in the United States.J. Hosp. Med. Sep 2009; 4: E1-E5https://doi.org/10.1002/jhm.445
- Ten-year trends in the use of catheter ablation for treatment of atrial fibrillation vs. the use of coronary intervention for the treatment of ischaemic heart disease in Australia.Europace. Dec 2013; 15: 1702-1709https://doi.org/10.1093/europace/eut162
- Trends in the use of electrical cardioversion for atrial fibrillation: influence of major trials and guidelines on clinical practice.BMC Cardiovasc. Disord. Jun 18 2012; 12: 42https://doi.org/10.1186/1471-2261-12-42
- Epidemiology of atrial fibrillation in the 21st century: novel methods and new insights.Circ. Res. Jun 19 2020; 127: 4-20https://doi.org/10.1161/CIRCRESAHA.120.316340
- Temporal trends in antithrombotic treatment of real-world UK patients with newly diagnosed atrial fibrillation: findings from the GARFIELD-AF registry.BMJ Open. Jan 13 2018; 8e018905https://doi.org/10.1136/bmjopen-2017-018905
- ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS.Eur. Heart J. Oct 7 2016; 37: 2893-2962https://doi.org/10.1093/eurheartj/ehw210
- AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Heart Rhythm Society.Circulation. Dec 2 2014; 130 (e199-267)https://doi.org/10.1161/CIR.0000000000000041
- Temporal trends in medication use and outcomes in atrial fibrillation.Can. J. Cardiol. Oct 2013; 29: 1241-1248https://doi.org/10.1016/j.cjca.2012.09.021
- National Trends in Atrial Fibrillation Hospitalization, Readmission, and Mortality for Medicare Beneficiaries, 1999–2013.Circulation. Mar 28 2017; 135: 1227-1239https://doi.org/10.1161/CIRCULATIONAHA.116.022388
- Association of left atrial metrics with atrial fibrillation Rehospitalization and adverse cardiovascular outcomes in patients with Nonvalvular atrial fibrillation following index hospitalization.J. Am. Soc. Echocardiogr. Oct 2021; 34 (1046–1055 e3)https://doi.org/10.1016/j.echo.2021.06.015
- Early rhythm-control therapy in patients with atrial fibrillation.N. Engl. J. Med. Oct 1 2020; 383: 1305-1316https://doi.org/10.1056/NEJMoa2019422
- Progression of atrial fibrillation after Cryoablation or drug therapy.N. Engl. J. Med. Jan 12 2023; 388: 105-116https://doi.org/10.1056/NEJMoa2212540
Article info
Publication history
Published online: April 07, 2023
Accepted:
April 4,
2023
Received in revised form:
March 22,
2023
Received:
November 15,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
