From 2003-2022, 5-year stroke or death risk decreased ~20% in AF patients; frail, ≥80, and mentally ill had lower OAC initiation rates (63.9%, 66.5%, 62.8%).
Have temporal trends in the risk of stroke and death, and initiation of oral anticoagulation, improved equally among potentially vulnerable subgroups of patients with atrial fibrillation?
Despite higher baseline risks, potentially vulnerable populations with AF experienced similar absolute reductions in stroke and mortality over the past 20 years, though disparities in OAC initiation persist for frail, elderly, and mentally ill patients.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background Atrial fibrillation (AF) is a growing global health concern, increasing stroke and mortality risk. While the treatment options for AF have improved over the past two decades, it remains unclear whether all patients have benefitted equally as disparities may persist among vulnerable populations. Purpose We examined temporal trends in the combined risk of stroke and death in the period 2003 to 2022 among patients with AF, stratified by potentially vulnerable subgroups. We also assessed trends in the initiation of oral anticoagulations (OAC). Methods Using Danish nationwide registers, we identified 262,694 patients aged ≥65 with a first-time AF diagnosis between 2003 and 2022. Patients were categorised into eight potentially vulnerable subgroups: Aged ≥80 (40%), female sex (49%, defined due to known health disparity in females), low income (25%), living alone (39%), history of mental illness (3%), non-Western immigrant (3%), frailty (25%), rural residence (39%). The potentially vulnerable subgroups were compared with their counterpart who did not have the risk factor. Patients were not mutually exclusive and could belong to multiple potentially vulnerable subgroups. The primary outcome of interest was the five-year absolute risk (AR) of the combined outcome of stroke or death by using Kaplan Meier estimates. Results Overall, the five-year AR of stroke or death decreased by 19.7% ((95% CI): 19.2–20.3) between 2003 and 2022. Patients in the potentially vulnerable subgroups exhibited a higher AR for the primary outcome than their counterparts, except from non-western immigrants with an AR of 55.5%(51.6–59.3) in 2003-2007 and 37.1%(33.9–40.3) in 2018-2022 (counterpart, 2003-2007: 60.5%(60.1–61.0), 2018-2022: 40.9%(40.4–41.3), while female sex and rural residence had comparable ARs as their counterparts. Risk reduction over time was similar across all groups, with an absolute risk reduction ranging from 17.3% to 21.9% from 2003 to 2022. The proportion of patients initiating OACs increased in all groups throughout the study period, although frail patients, patients aged ≥80 and patients with a history of mental illness were less likely to be initiated in OACs compared to their counterparts. In 2018-2022, 63.9% of the frail patients were initiated in OACs (counterpart: 78.1%), 66.5% of the patients aged ≥80 (counterpart: 79.2%), and 62.8% of patients with a history of mental illness (counterpart: 75.1%). Conclusion Despite a higher baseline risk, potentially vulnerable populations experienced a similar absolute reduction in stroke and mortality over time, suggesting overall progress in prognosis. Female sex, non-Western immigrants, and rural residence did not appear to constitute a vulnerable group. OAC initiation increased across all groups, though frail patients, those aged ≥80, and those with a history of mental illness were less frequently initiated, indicating a persistent difference in OAC use.Figure 1)5-year cumulative incidens Figure 2)Initiation of OAC
Austreim et al. (Sat,) reported a other. From 2003-2022, 5-year stroke or death risk decreased ~20% in AF patients; frail, ≥80, and mentally ill had lower OAC initiation rates (63.9%, 66.5%, 62.8%).