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Am Heart J. 2011 May;161(5):986-992.e1. doi: 10.1016/j.ahj.2011.02.001.

The epidemiology of atrial fibrillation in adults depends on locale of diagnosis.

Author information

1
Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada. rsandhu2@ualberta.ca

Abstract

BACKGROUND:

Previous studies on atrial fibrillation (AF) epidemiology have used various case definitions for AF, but the effect of location of diagnosis on the apparent epidemiology of AF is unknown.

METHODS:

Population-based study of 46,440 consecutive patients with newly diagnosed AF in Alberta, Canada, from 2000 to 2005.

RESULTS:

Of adults newly diagnosed with AF (52.8% men, median 73 years), 51.8% were first diagnosed in hospital, 19.2% in emergency department (ED), and 29.0% in outpatient clinics. Prevalence of AF increased from 613 per 100,000 to 1,148 per 100,000 population over 5 years; however, the age- and sex-standardized incidence of AF remained relatively stable (350 per 100,000 in 2000 and 352 per 100,000 in 2005). The proportion of AF cases diagnosed in hospital declined 21% between 2000 and 2005, whereas the proportion of cases diagnosed in the outpatient setting rose by 50% (P < .0001). Patients diagnosed with AF in the hospital or the ED had more comorbidities and higher CHADS(2) (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack) scores than those diagnosed in the outpatient setting (all P < .0001). Multivariate adjusted risk of cerebrovascular events or mortality (adjusted odds ratios 4.3, 95% CI 3.9-4.7) was significant for hospital and ED AF diagnosis (adjusted odds ratios 2.4, 95% CI 2.2-2.7) compared with those diagnosed in primary care clinics. New heart failure in the year after diagnosis of AF was 4.5% for inpatients, 3.8% in ED patients, and 2.5% in outpatients.

CONCLUSIONS:

Use of hospitalizations alone to define an AF cohort may underestimate incidence while overestimating comorbiditities, thromboembolic risk, and outcomes.

PMID:
21570533
DOI:
10.1016/j.ahj.2011.02.001
[Indexed for MEDLINE]

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