Temporal trends in loss of expected lifetime associated with cardiovascular complications following newly diagnosed atrial fibrillation: a Danish nationwide cohort study from 2000 to 2022

AIMS: While advancements in care may improve the clinical course of atrial fibrillation (AF), data on trends in lost lifetime after developing cardiovascular complications are sparse. METHODS AND RESULTS: In this nationwide registry-based matched cohort study (1 January 2000-31 December 2022), we followed patients with ischaemic stroke, gastrointestinal bleeding, intracranial bleeding, heart failure (HF), and myocardial infarction (MI) after AF and matched referents with AF. We estimated the average loss of life expectancy as the difference in restricted mean survival time between patients with AF with and without a complication and compared the loss between 2000-10 and 2011-22. We followed 27 809 patients with ischaemic stroke, 28 938 with gastrointestinal bleeding, 7710 with intracranial bleeding, 50 914 with HF, and 14 141 with MI and their matched referents. The loss of lifetime improved for ischaemic stroke [-2.1 vs. -1.8 years; difference 4.0 months, 95% confidence interval (CI) 2.4-5.6; P < 0.001]. We found no evidence of trends for gastrointestinal (-1.7 vs. -1.8 years; difference -0.8 months, 95% CI -2.5 to 0.8; P = 0.32) or intracranial bleeding (-3.3 vs. -3.1 years; difference 1.6 months, 95% CI -1.3 to 4.6; P = 0.28). The loss of lifetime improved for HF (-2.1 vs. -1.9 years; difference 2.4 months, 95% CI 0.9-3.8; P = 0.001) and MI (-1.6 vs. -1.1 years; difference 5.9 months, 95% CI 3.3-8.5; P < 0.001). CONCLUSION: Among patients with AF, the loss of expected lifetime after incident ischaemic stroke, HF, and MI improved modestly over the past two decades but not after gastrointestinal or intracranial bleeding. These findings support the development and evaluation of interventions that prevent and reduce severity of complications after AF, particularly for bleeding.