Age-Specific Incidence, Outcome, Cost and Projected Future Burden of Atrial Fibrillation-Related Embolic Vascular Events: A Population-Based Study
Background—Prevalence of atrial fibrillation (AF) is over 10% at age ≥80 years, but the impact of population ageing on rates of AF-related ischaemic events is uncertain.
Methods and Results—We studied age-specific incidence, outcome and cost of all AF-related incident strokes and systemic emboli from 2002-2012 in the Oxford Vascular Study (OXVASC). We determined trends in incidence of AF-related stroke since a sister study in 1981-1986, extrapolated numbers to the UK population and projected future numbers. Of 3096 acute cerebral or peripheral vascular events in the 92,728 study population, 383 incident ischaemic strokes and 71 systemic emboli were related to AF, of which 272 (59.9%) occurred at ≥80 years. Of 597 fatal or disabling incident ischaemic strokes, 262 (43•9%) were AF related. Numbers of AF-related ischaemic strokes at age ≥80 increased nearly three-fold from 1981-1986 to 2002-2012 (extrapolated to the UK: 6621 to 18,176), due partly to increased age-specific incidence (RR 1.52, 96%CI 1.31-1.77, p=0.001), with potentially preventable AF-related events at age≥80 costing the UK £374 million/year. At current incidence rates, numbers of AF-related embolic events at age ≥80 will treble again by 2050 (72,974/year), with 83.5% of all events occurring in this age group.
Conclusions—Numbers of AF-related incident ischaemic strokes at age ≥80 years have trebled over the last 25 years, despite the introduction of anticoagulants, and are projected to treble again by 2050, along with the numbers of systemic emboli. Improved prevention in older people with AF should be a major public health priority.
- Received May 1, 2014.
- Revision received July 31, 2014.
- Accepted August 5, 2014.