2013年至2019年医疗保险受益人心房颤动患者的发病率、患病率、死亡率及中风趋势
Incidence, Prevalence, and Trends in Mortality and Stroke Among Medicare Beneficiaries With Atrial Fibrillation: 2013 to 2019.
作者信息
Rogovoy Nichole M, Kearing Stephen, Zhou Weiping, Freeman James V, Piccini Jonathan P, Al-Khatib Sana M, Zeitler Emily P
机构信息
Department of Medicine & Heart and Vascular Center, Division of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon NH (N.M.R., S.K., W.Z., E.P.Z.).
Department of Medicine, Yale School of Medicine, New Haven, CT (J.V.F.).
出版信息
Circ Cardiovasc Qual Outcomes. 2025 May;18(5):e011365. doi: 10.1161/CIRCOUTCOMES.124.011365. Epub 2025 Apr 4.
BACKGROUND
Atrial fibrillation (AF) is known to be associated with increased risks of stroke and death, but contemporary studies of this association are lacking. We evaluated trends in stroke and death among Medicare beneficiaries with AF between 2013 and 2019.
METHODS
Medicare fee-for-service beneficiaries >65 years old (2011-2019) were included. AF incidence and prevalence were calculated overall and by age group, sex, race, and rurality. Within incident cohorts, the 1-year stroke rate was assessed. Age- and sex-adjusted mortality at 30 days, 1 year, and 3 years was calculated in each incident cohort.
RESULTS
The mean number of Medicare beneficiaries with incident AF per year was 572 630 from 2013 to 2019 (30.44 per 1000 patient-years). The study cohort on average was 79±7.7 years old, 52% female, 88% white, and 83% urban dwelling. Incidence and prevalence of AF increased with age and was highest among White beneficiaries; the incidence was greater in male compared with female beneficiaries. Differences by rurality were not seen. Overall AF prevalence per 1000 beneficiaries increased minimally but steadily from 2013 to 2019 reflecting an increase among male (104-109 per 1000) but not female beneficiaries (82.5 per 1000). The 1-year rate of stroke after incident AF peaked in the 2015 cohort (50.5 per 1000); the rate was at its lowest among the 2018 cohort (41.89 per 1000). Incident AF was associated with mortality that was 3.2× greater than expected at 1 year, but overall mortality and the magnitude of the AF-related mortality risk decreased steadily over time from 22% to 20%.
CONCLUSIONS
From 2013 to 2019, AF incidence and prevalence among Medicare beneficiaries were relatively stable but have varied by important demographic subgroups with age and sex remaining powerful risk factors. In contrast, mortality and stroke after incident AF have decreased significantly throughout this era.
背景
已知心房颤动（AF）与中风和死亡风险增加有关，但缺乏对此关联的当代研究。我们评估了2013年至2019年间患有AF的医疗保险受益人的中风和死亡趋势。
方法
纳入年龄>65岁（2011 - 2019年）的医疗保险按服务收费受益人。总体及按年龄组、性别、种族和城乡分布计算AF发病率和患病率。在新发队列中，评估1年中风率。计算每个新发队列在30天、1年和3年时经年龄和性别调整的死亡率。
结果
2013年至2019年，每年新发AF的医疗保险受益人平均数量为572630人（每1000患者年30.44人）。研究队列平均年龄为79±7.7岁，52%为女性，88%为白人，83%居住在城市。AF的发病率和患病率随年龄增加而升高，在白人受益人中最高；男性受益人的发病率高于女性受益人。未观察到城乡差异。每1000名受益人中AF的总体患病率从2013年到2019年略有但稳步上升，反映出男性（每1000人从104升至109）而非女性受益人（每1000人82.5）患病率增加。新发AF后1年中风率在2015年队列中达到峰值（每1000人50.5）；在2018年队列中最低（每1000人41.89）。新发AF与1年时高于预期3.2倍的死亡率相关，但总体死亡率以及AF相关死亡风险幅度随时间从22%稳步降至20%。
结论
2013年至2019年，医疗保险受益人中AF的发病率和患病率相对稳定，但在重要人口亚组中有所不同，年龄和性别仍是强大的风险因素。相比之下，在此期间，新发AF后的死亡率和中风率显著下降。
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