Factors Associated With the Epidemic of Hospitalizations Due to Atrial Fibrillation

doi:10.1016/j.amjcard.2012.07.011

The American Journal of Cardiology

Volume 110, Issue 10, 15 November 2012, Pages 1496-1499

This study was presented in part at the European Society of Cardiology Congress, Stockholm, Sweden, August 2010 and published in abstract form (Eur Heart J 2010;31:S166).

https://doi.org/10.1016/j.amjcard.2012.07.011 Get rights and content

Recent reports have described that hospitalizations for atrial fibrillation (AF) are continuing to increase. Given that hospitalizations are responsible for most of the economic burden associated with AF, the aim of this study was to characterize the impact of age and how changing procedural practices may be contributing to the increasing rates of AF hospitalizations. The annual age- and gender-specific incidence of hospitalizations for AF, electrical cardioversions, electrophysiologic studies, and radiofrequency ablation procedures in Australia were determined from 1993 to 2007 inclusive. Over this 15-year follow-up period spanning almost 300 million person-years, a total of 473,501 hospitalizations for AF were identified. There was a relative increase in AF hospitalizations of 203% over the study period, in contrast to an increase for all hospitalizations of only 71%. Whereas the gender-specific incidence of hospitalizations remained stable, the age-specific incidence increased significantly over the study period, particularly in older age groups. AF hospitalizations associated with electrical cardioversions decreased from 27% to 14% over the study period. Electrophysiologic studies and radiofrequency ablation procedures contributed minimally to the overall increase in AF hospitalizations observed. In conclusion, in addition to the growing prevalence of AF because of the aging population, there is an increasing age-specific incidence of hospitalizations for AF, particularly in older age groups. In contrast, changing procedural trends have contributed minimally to the increasing number of AF-associated hospitalizations. Greater attention to older patients with AF is required to develop strategies to prevent hospitalizations and contain the growing burden on health care systems.

Section snippets

Methods

Data were obtained from the National Hospital Morbidity Dataset, a source maintained by the Australian Institute of Health and Welfare that includes inpatient information at every hospital in Australia. The proportion of missing data is negligible, representing <0.004% of cases per year.

We identified hospitalizations with principal diagnoses of AF across a 15-year period from 1993 through 2007 inclusive. The International Classification of Diseases, Ninth Revision, Clinical Modification, and

Results

Over a 15-year period from 1993 to 2007, there were a total of 93,029,656 hospitalizations for any diagnosis in Australia (representing a follow-up period of almost 300 million person-years). There were a total of 473,501 hospitalizations for AF. There was a relative increase of 203% in the number of AF hospitalizations (7.9% annually, rate ratio [RR] 1.079, 95% confidence interval [CI] 1.069 to 1.088, p <0.001; Table 1). This was in contrast to a relative increase in the number of all

Discussion

We examined nationwide trends in hospitalizations for AF in Australia over a 15-year period to determine factors that might be contributing to the increasing rates of hospitalizations for this prolific condition. Our findings highlight that the age-specific incidence of hospitalizations for AF is continuing to increase. Not only are aging population structures resulting in a growing prevalence of AF, but elderly patients in particular are being hospitalized for AF at an increasing rate. Our

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Procedural and principal diagnosis data were extracted from the NHMD as previously described in the literature.36 The NHMD is compiled from data supplied by Australian state and territory health authorities and contains deidentified electronic summary records of inpatient episodes of care in Australian public and private hospitals, with a negligible proportion of missing data (0.004% of cases per year).35 The data do not include outpatient episodes of care.
There is no consensus as to the treatment of proximal humeral fractures (PHFs), particularly in elderly patients. There is increasing evidence that nonoperative management may have similar functional outcomes to operative management, which is potentially conflicting with increasingly improved surgical techniques and implants. The aim of this study was to investigate the changes in the incidence and management of PHFs across Australia over a 10-year period.
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The incidence of PHFs increased from 26.8 per 100,000 person-years in 2008 to 45.7 per 100,000 person-years in 2017. There was a decrease in operative management from 2008 to 2017, with 32.5% and 22.8% of all PHFs treated operatively in 2008 and 2017, respectively (P = .001). ORIF use decreased significantly from 76.6% to 72.6% (P = .004). RTSA use increased significantly from 4.1% to 24.5% (P < .001). HA use decreased significantly from 19.3% to 3% (P < .001).
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To determine if increasing hospitalisations for non-valvular atrial fibrillation (NVAF) in Western Australia (WA) was due to incident (first-ever) or repeat hospitalisations, an ageing population structure, changing procedural practice or a combination of these factors.
We conducted a longitudinal retrospective population study on all WA residents aged 25–94 years between 2000 and 2013, with a principal hospital discharge diagnosis of NVAF. Person-linked hospital morbidity and mortality records were used to measure annual rate ratios (RRs) and 95% confidence intervals (CIs) in the total and incident NVAF (25–94 years) hospitalisations, further stratified by sex and by age-specific standardised groups (25–44, 45–64, 65–75, 75–84, 85–94 years).
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It is suspected that these trends are largely driven by ageing population structures and recurrent hospitalisations in symptomatic individuals [77]. However, there is also data to suggest that the age-specific rate of AF hospitalisations is increasing [78]. It is possible that worsening risk factor profiles independent of ageing populations are driving these trends, and this supports the likely benefit of aggressive risk factor management discussed later [79].
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In this analysis, patient age (P = .21), ablation time (P = .53), additional substrate modification (P = .915), type of AF (P = .29), rhythm at PVI (P = .20), and use of adenosine (P = .053) and CF catheters (P = .09) were not significant multivariate predictors of recurrence. AF has been described as an emerging epidemic,4 and AF ablation has become an increasingly used treatment strategy. In the initial decade of AF ablation, reported mean fluoroscopy times in excess of 50 minutes were the norm.5,6
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: Dr. Wong is supported by a Rhodes Scholarship from the Rhodes Trust. Drs. Brooks, Roberts-Thomson, and Sanders are supported by the National Heart Foundation of Australia. Drs. Lau and Leong are supported by a postdoctoral fellowship from the National Health and Medical Research Council of Australia. Dr. Leong is supported by the National Heart Foundation of Australia and the Royal Australasian College of Physicians.

: Dr. Roberts-Thomson has served on the advisory board of St. Jude Medical, St. Paul, Minnesota. Dr. Sanders has served on the advisory board of St. Jude Medical; Bard Electrophysiology, Lowell, Massachusetts; Biosense Webster, Diamond Bar, California; Medtronic, Minneapolis, Minnesota; Sanofi-Aventis, Paris, France; and Merck, Whitehouse Station, New Jersey. Dr. Sanders has received lecture fees from St. Jude Medical, Bard Electrophysiology, Biosense Webster, Medtronic, and Merck. Dr. Sanders has received research funding from St. Jude Medical, Bard Electrophysiology, Biosense Webster, and Medtronic.

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Arrhythmias and conduction disturbancesFactors Associated With the Epidemic of Hospitalizations Due to Atrial Fibrillation

Section snippets

Methods

Results

Discussion

Am Heart J

Am J Cardiol

Arch Cardiovasc Dis

Ann Emerg Med

Value Health

Am Heart J

Ann Epidemiol

J Am Coll Cardiol

J Am Coll Cardiol

Heart Rhythm

Heart Rhythm

Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study

JAMA

Arrhythmias and conduction disturbances
Factors Associated With the Epidemic of Hospitalizations Due to Atrial Fibrillation