Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
IngenioRX, Indianapolis, IN, USA.
Int J Clin Pract. 2021 May;75(5):e14042. doi: 10.1111/ijcp.14042. Epub 2021 Feb 17.
Identification of published data on prevalent/incidence of atrial fibrillation/flutter (AF) often relies on inpatient/outpatient claims, without consideration to other types of healthcare services and pharmacy claims. Accurate, population-level data that can enable the ongoing monitoring of AF epidemiology, quality of care at affordable cost, and complications are needed. We hypothesised that prevalent/incidence data would vary via the use of integrated medical/pharmacy claims, and associated comorbidities would vary accordingly.
To examine AF prevalence/incidence and associated individual comorbidity and multi-morbidity profiles for a large US adult cohort spanning across a wide age range for both males/females based on both integrated criteria from both medical/pharmacy claims.
We studied a population of 8 343 992 persons across many geographical areas in the US continent from 1 January/2016 to 31 October 2019. The prevalence and incidence of AF were comparatively analysed for different healthcare parameters (eg, emergency room visit, anticoagulant medication, heart rhythm control medication) and for integrated criteria based on medical/pharmacy claims.
Based on integrated medical and pharmacy claims, AF prevalence was 12.7% in the elderly population (≥65 years) and 0.9% in the younger population (<65 years). These prevalence rates are different from estimates provided by the US CDC for those aged ≥65 years (9%) and age <65 years (2%); thus, the prevalence is under-estimated in the elderly population and over-estimated in the younger population. The incidence ratios for elderly females relative to younger females was 15.07 (95%CI 14.47-15.70), a value that is about 50% higher than for elderly males (10.57 (95%CI 10.24-10.92)). Comorbidity risk profile for AF identified on the basis of medical and pharmacy criteria varied by age and gender. The proportion with multi-morbidity (defined as ≥2 long term comorbidities) was 10%-12%.
Continued reliance only on outpatient and inpatient claims greatly underestimates AF prevalence and incidence in the general population by over 100%. Multi-morbidity is common amongst AF patients, affecting approximately 1 in 10 patients. AF patients with four or more co-morbidities captured 20%-40% of the AF cohorts depending on age groups and prevalent or incident cases.
在识别心房颤动/扑动（AF）的发病/患病率时，通常依赖于住院/门诊报销数据，而不考虑其他类型的医疗服务和药房报销数据。需要准确、基于人群水平的数据，以便能够持续监测 AF 的流行病学、以可负担的成本提供高质量的护理以及监测并发症。我们假设，通过使用综合医疗/药房报销数据，发病/患病率数据会有所不同，并且相关合并症也会相应变化。
根据综合医疗/药房报销数据，为男性/女性跨越广泛年龄范围的大型美国成年队列检查 AF 的患病率/发病率以及相关的个体合并症和多种合并症特征。
我们研究了美国大陆许多地理区域的 8343992 人，研究时间从 2016 年 1 月 1 日至 2019 年 10 月 31 日。根据不同的医疗保健参数（例如急诊就诊、抗凝药物、心律控制药物）和基于医疗/药房报销数据的综合标准，对 AF 的发病/患病率进行了比较分析。
根据综合医疗和药房报销数据，老年人群（≥65 岁）的 AF 患病率为 12.7%，年轻人群（<65 岁）的患病率为 0.9%。这些患病率与美国疾病预防控制中心为≥65 岁人群（9%）和<65 岁人群（2%）提供的估计值不同；因此，老年人群的患病率被低估，而年轻人群的患病率被高估。与年轻女性相比，老年女性的发病比值比为 15.07（95%CI 14.47-15.70），这一数值比老年男性高出约 50%（10.57（95%CI 10.24-10.92））。基于医疗和药房标准确定的 AF 合并症风险特征因年龄和性别而异。患有多种合并症（定义为≥2 种长期合并症）的比例为 10%-12%。
仅依靠门诊和住院报销数据，会使一般人群中 AF 的患病率和发病率被严重低估 100%以上。AF 患者中合并症很常见，约影响 10%的患者。根据年龄组和发病或发病病例，患有四种或更多合并症的 AF 患者占 AF 队列的 20%-40%。
