Tom Briffa1, Joseph Hung2, Matthew Knuiman1, Brendan McQuillan3, Derek P Chew4, John Eikelboom5, Graeme J Hankey1, Tiew-Hwa K Teng6, Lee Nedkoff1, Rukshen Weerasooriya7, Andrew Liu8, Paul Stobie9. 1. School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia. 2. School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Crawley, Western Australia, Australia. Electronic address: joe.hung@uwa.edu.au. 3. School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Crawley, Western Australia, Australia. 4. School of Medicine, Flinders University of South Australia, Adelaide, South Australia, Australia. 5. Department of Medicine, McMaster University, Hamilton, Canada. 6. Western Australian Centre for Rural Health, The University of Western Australia, Crawley, Western Australia, Australia. 7. Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia. 8. Department of Cardiology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia. 9. Department of Cardiovascular Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Abstract
OBJECTIVE: Hospitalization for atrial fibrillation (AF) is a large and growing public health problem. We examined current trends in the incidence, prevalence, and associated mortality of first-ever hospitalization for AF. METHODS: Linked hospital admission data were used to identify all Western Australia residents aged 35-84 years with prevalent AF and incident (first-ever) hospitalization for AF as a principal or secondary diagnosis during 1995-2010. RESULTS: There were 57,552 incident hospitalizations, mean age 69.8 years, with 41.4% women. Over the calendar periods, age- and sex-standardized incidence of hospitalization for AF as any diagnosis declined annually by 1.1% (95% CI; 0.93, 1.29), while incident AF as a principal diagnosis increased annually by 1.2% (95% CI; 0.84, 1.50). Incident AF hospitalization was higher among men than women, and 15-fold higher in the 75-84 compared with 35-64 year age group. The age- and sex-standardized prevalence of AF increased annually by 2.0% (95% CI; 1.88, 2.03) over the same period. Comorbidity trends were mixed with diabetes and valvular heart disease increasing, and hypertension, coronary artery disease, heart failure, cerebrovascular disease, and chronic kidney disease decreasing. The 1-year all-cause mortality after incident AF hospitalization declined from 17.6% to 14.6% (trend P<0.001), with an adjusted hazard ratio of 0.86 (95% CI; 0.81, 0.91). CONCLUSION: This contemporary study shows that incident AF hospitalization is not increasing except for AF as a principal diagnosis, while population prevalence of hospitalized AF has risen substantially. The high 1-year mortality following incident AF hospitalization has improved only modestly over the recent period.
OBJECTIVE: Hospitalization for atrial fibrillation (AF) is a large and growing public health problem. We examined current trends in the incidence, prevalence, and associated mortality of first-ever hospitalization for AF. METHODS: Linked hospital admission data were used to identify all Western Australia residents aged 35-84 years with prevalent AF and incident (first-ever) hospitalization for AF as a principal or secondary diagnosis during 1995-2010. RESULTS: There were 57,552 incident hospitalizations, mean age 69.8 years, with 41.4% women. Over the calendar periods, age- and sex-standardized incidence of hospitalization for AF as any diagnosis declined annually by 1.1% (95% CI; 0.93, 1.29), while incident AF as a principal diagnosis increased annually by 1.2% (95% CI; 0.84, 1.50). Incident AF hospitalization was higher among men than women, and 15-fold higher in the 75-84 compared with 35-64 year age group. The age- and sex-standardized prevalence of AF increased annually by 2.0% (95% CI; 1.88, 2.03) over the same period. Comorbidity trends were mixed with diabetes and valvular heart disease increasing, and hypertension, coronary artery disease, heart failure, cerebrovascular disease, and chronic kidney disease decreasing. The 1-year all-cause mortality after incident AF hospitalization declined from 17.6% to 14.6% (trend P<0.001), with an adjusted hazard ratio of 0.86 (95% CI; 0.81, 0.91). CONCLUSION: This contemporary study shows that incident AF hospitalization is not increasing except for AF as a principal diagnosis, while population prevalence of hospitalized AF has risen substantially. The high 1-year mortality following incident AF hospitalization has improved only modestly over the recent period.