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Atrial fibrillation prevalence and incidence varies by population definition: Association with co-morbidity profiles and multimorbidity in a large United States adult cohort
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  • Ash Genaidy,
  • Gregory Lip,
  • George Tran,
  • Patricia Marroquin,
  • Cara Estes
Ash Genaidy
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Gregory Lip
University of Liverpool
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George Tran
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Patricia Marroquin
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Cara Estes
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Abstract

Background 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. Purpose 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 medical/pharmacy claims. Methods We studied a population of 8,343,992 persons across many geographical areas in the U.S. continent from 1 January /2016 to 31 October 2019. The prevalence and incidence of AF were comparatively analyzed for different healthcare parameters. Results 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 sex. The proportion with multimorbidity (defined as ≥2 long term comorbidities) was 10-12%. Conclusion Continued reliance only on outpatient and inpatient claims greatly underestimates AF prevalence and incidence in the general population by over 100%. Multimorbidity is common amongst AF patients, affecting approximately 1 in 10 patients. AF patients with 4 or more co-morbidities captured 20 to 40% of the AF cohorts depending on age groups and prevalent or incident cases. Our proposed methodology can guide future analysis of quality/cost of care for progressive medical conditions at the population level.

Peer review status:ACCEPTED

12 Oct 2020Submitted to International Journal of Clinical Practice
14 Oct 2020Submission Checks Completed
14 Oct 2020Assigned to Editor
14 Oct 2020Reviewer(s) Assigned
12 Dec 2020Review(s) Completed, Editorial Evaluation Pending
22 Dec 20201st Revision Received
23 Dec 2020Reviewer(s) Assigned
23 Dec 2020Submission Checks Completed
23 Dec 2020Assigned to Editor
01 Jan 2021Review(s) Completed, Editorial Evaluation Pending
19 Jan 2021Editorial Decision: Accept