Incidence of clinical atrial fibrillation and related complications using a screening algorithm at a nationwide level



Roger, Antoine, Cottin, Yves, Bentounes, Sid Ahmed, Bisson, Arnaud ORCID: 0000-0002-3449-1800, Bodin, Alexandre, Herbert, Julien, Maille, Baptiste, Zeller, Marianne, Deharo, Jean Claude, Lip, Gregory YH ORCID: 0000-0002-7566-1626
et al (show 1 more authors) (2023) Incidence of clinical atrial fibrillation and related complications using a screening algorithm at a nationwide level. EUROPACE, 25 (5). euad063-.

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Abstract

<h4>Aims</h4>In a recent position paper, the European Heart Rhythm Association (EHRA) proposed an algorithm for the screening and management of arrhythmias using digital devices. In patients with prior stroke, a systematic screening approach for atrial fibrillation (AF) should always be implemented, preferably immediately after the event. Patients with increasing age and with specific cardiovascular or non-cardiovascular comorbidities are also deemed to be at higher risk. From a large nationwide database, the aim was to analyse AF incidence rates derived from this new EHRA algorithm.<h4>Methods and results</h4>Using the French administrative hospital discharge database, all patients hospitalized in 2012 without a history of AF, and with at least a 5-year follow-up (FU) (or if they died earlier), were included. The yearly incidence of AF was calculated in each subgroup defined by the algorithm proposed by EHRA based on a history of previous stroke, increasing age, and eight comorbidities identified via International Classification of Diseases 10th Revision codes. Out of the 4526 104 patients included (mean age 58.9 ± 18.9 years, 64.5% women), 1% had a history of stroke. Among those with no history of stroke, 18% were aged 65-74 years and 21% were ≥75 years. During FU, 327 012 patients had an incidence of AF (yearly incidence 1.86% in the overall population). Implementation of the EHRA algorithm divided the population into six risk groups: patients with a history of stroke (group 1); patients > 75 years (group 2); patients aged 65-74 years with or without comorbidity (groups 3a and 3b); and patients < 65 years with or without comorbidity (groups 4a and 4b). The yearly incidences of AF were 4.58% per year (group 2), 6.21% per year (group 2), 3.50% per year (group 3a), 2.01% per year (group 3b), 1.23% per year (group 4a), and 0.35% per year (group 4b). In patients aged < 65 years, the annual incidence of AF increased progressively according to the number of comorbidities from 0.35% (no comorbidities) to 9.08% (eight comorbidities). For those aged 65-75 years, the same trend was observed, i.e. increasing from 2.01% (no comorbidities) to 11.47% (eight comorbidities).<h4>Conclusion</h4>These findings at a nationwide scale confirm the relevance of the subgroups in the EHRA algorithm for identifying a higher risk of AF incidence, showing that older patients (>75 years, regardless of comorbidities) have a higher incidence of AF than those with prior ischaemic stroke. Further studies are needed to evaluate the usefulness of algorithm-based risk stratification strategies for AF screening and the impact of screening on major cardiovascular event rates.

Item Type: Article
Uncontrolled Keywords: Atrial fibrillation, Score, Ischaemic stroke, Prognosis, EHRA
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 18 May 2023 13:30
Last Modified: 06 Jun 2023 12:24
DOI: 10.1093/europace/euad063
Open Access URL: https://doi.org/10.1093/europace/euad063
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3170498