Incidence and Prevalence of Atrial Fibrillation and Associated Mortality Among Medicare Beneficiaries: 1993–2007

Author:

Piccini Jonathan P.1,Hammill Bradley G.1,Sinner Moritz F.1,Jensen Paul N.1,Hernandez Adrian F.1,Heckbert Susan R.1,Benjamin Emelia J.1,Curtis Lesley H.1

Affiliation:

1. From the Duke Clinical Research Institute (J.P.P., B.G.H., A.F.H., L.H.C.) and Department of Medicine (J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Department of Medicine I, University Hospital Grosshadern, Ludwig-Maximilians University Munich, Munich, Germany (M.F.S.); Department of Epidemiology, University of Washington School of Public Health, Seattle, WA (P.N.J., S.R.H.); Department of Medicine, Boston University School of Medicine, Boston, MA (E.J.B.).

Abstract

Background— Atrial fibrillation (AF) is a common and costly problem among older persons. The frequency of AF increases with age, but representative national data about incidence and prevalence are limited. We examined the annual incidence, prevalence, and mortality associated with AF among older persons. Methods and Results— In a retrospective cohort study of Medicare beneficiaries 65 years and older diagnosed with AF between 1993 and 2007, we measured annual age- and sex-adjusted incidence and prevalence of AF and mortality following an AF diagnosis. Among 433 123 patients with incident AF, the mean age was 80 years, 55% were women, and 92% were white. The incidence of AF remained steady during the 14-year study period, ranging from 27.3 to 28.3 per 1000 person-years. Incidence rates were consistently higher among men and white beneficiaries. The prevalence of AF increased across the study period (mean, 5% per year) and was robust to sensitivity analyses. Among beneficiaries with incident AF in 2007, 36% had heart failure, 84% had hypertension, 30% had cerebrovascular disease, and 8% had dementia. Mortality after AF diagnosis declined slightly over time but remained high. In 2007, the age- and sex-adjusted mortality rates were 11% at 30 days and 25% at 1 year. Conclusions— Among older Medicare beneficiaries, incident AF is common and has remained relatively stable for more than a decade. Incident AF is associated with significant comorbidity and mortality; death occurs in one-quarter of beneficiaries within 1 year.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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