Key result
Diagnosis of atrial fibrillation in 2016/17 compared to 2001/02 was associated with decreased 1-year all-cause mortality (RR 0.72; 95% CI 0.65-0.80) but increased overall hospitalization.
Why the study?
Reports of outcomes after atrial fibrillation diagnosis have been conflicting, leaving trends in cause-specific mortality and hospitalization uncertain.
Cohort (n=72,412)
Yes
While cardiovascular and cerebrovascular mortality after incident atrial fibrillation have declined over time, non-cardiovascular hospitalizations and deaths from causes like dementia have increased.
Answers are grounded in this paper and cite their sources.
Declining cause-specific post-AF mortality may aid prognostication; leaves open hospitalization trends and patient-feature interactions.
BACKGROUND AND AIMS: Reports of outcomes after atrial fibrillation (AF) diagnosis are conflicting. The aim of this study was to investigate mortality and hospitalization rates following AF diagnosis over time, by cause and by patient features. METHODS: Individuals aged ≥16 years with a first diagnosis of AF were identified from the UK Clinical Practice Research Datalink-GOLD dataset from 1 January 2001, to 31 December 2017. The primary outcomes were all-cause and cause-specific mortality and hospitalization at 1 year following diagnosis. Poisson regression was used to calculate rate ratios (RRs) for mortality and incidence RRs (IRRs) for hospitalization and 95% confidence intervals (CIs) comparing 2001/02 and 2016/17, adjusted for age, sex, region, socio-economic status, and 18 major comorbidities. RESULTS: Of 72 412 participants, mean (standard deviation) age was 75.6 (12.4) years, and 44 762 (61.8%) had ≥3 comorbidities. All-cause mortality declined (RR 2016/17 vs. 2001/02 0.72; 95% CI 0.65-0.80), with large declines for cardiovascular (RR 0.46; 95% CI 0.37-0.58) and cerebrovascular mortality (RR 0.41; 95% CI 0.29-0.60) but not for non-cardio/cerebrovascular causes of death (RR 0.91; 95% CI 0.80-1.04). In 2016/17, deaths caused from dementia (67, 8.0%), outstripped deaths from acute myocardial infarction, heart failure, and acute stroke combined (56, 6.7%, P < .001). Overall hospitalization rates increased (IRR 2016/17 vs. 2001/02 1.17; 95% CI, 1.13-1.22), especially for non-cardio/cerebrovascular causes (IRR 1.42; 95% CI 1.39-1.45). Older, more deprived, and hospital-diagnosed AF patients experienced higher event rates. CONCLUSIONS: After AF diagnosis, cardio/cerebrovascular mortality and hospitalization has declined, whilst hospitalization for non-cardio/cerebrovascular disease has increased.
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Wu et al. (2023) conducted a cohort in atrial fibrillation (n=72,412). Diagnosis in 2016/17 vs. Diagnosis in 2001/02 was evaluated on all-cause mortality at 1 year following diagnosis (RR 0.72, 95% CI 0.65-0.80). Diagnosis of atrial fibrillation in 2016/17 compared to 2001/02 was associated with decreased 1-year all-cause mortality (RR 0.72; 95% CI 0.65-0.80) but increased overall hospitalization.
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