Trends in the Incidence of Atrial Fibrillation in Older Patients Initiating Dialysis in the United States
Background—One sixth of U.S. dialysis patients older than 65 years have been diagnosed with atrial fibrillation/flutter (AF). Little is known, however, about the incidence of AF in this population.
Methods and Results—We identified 258,605 older patients (≥67 years) with fee-for-service Medicare initiating dialysis in 1995-2007, who had not been diagnosed with AF within the previous 2 years. Patients were followed for newly diagnosed AF. Multivariable proportional hazards regression was used to examine temporal trends and associations of race and ethnicity with incident AF. We also studied temporal trends in the mortality and risk of ischemic stroke after new AF. Over 514,395 person years of follow-up, 76,252 patients experienced incident AF for a crude AF incidence rate of 148/1,000 person years. Incidence of AF increased by 11% (95%CI: 5%-16%) from 1995-2007. Compared with non-Hispanic whites, African Americans (-30%), Asians (-19%), Native Americans (-42%), and Hispanics (-29%) all had lower rates of incident AF. Mortality after incident AF decreased by 22% from 1995-2008. Even more pronounced reductions were seen for incident ischemic stroke during these years.
Conclusions—The incidence of AF is high in older patients initiating dialysis in the U.S. and has been increasing over the 13 years of study. Mortality declined during that time, but remained >50% during the first year after newly diagnosed AF. Since data on warfarin use were not available, we were unable to study whether trends towards better outcomes could be explained by higher rates of oral anticoagulation.
- Received February 15, 2012.
- Accepted September 20, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited