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Atrial fibrillation (AF) more than twice as prevalent as thought - and it is increasing!
Henry I. Bussey, Pharm.D.
Reference: Miyasaka Y, Barnes ME, Gersh BJ, et al. Secular trends in incidence of atrial fibrillation on Olmsted County, Minnesota, 1980 - 2000 and implications fon the projections for future prevalence. Circulation 2006; 114:119-125.
In a recent issue of Circulation, investigators at Mayo Clinic in Rochester, MN report the findings of a twenty year study of the inhabitants of Olmsted County, MN. During the study, 4,618 new cases of ECG-confirmed AF were identified. The incidence of new AF in 1980 (3.04 per 1000 person-years) increased to 3.68 per 1000 person-years by 2000. Based on these findings, the group estimated that the current incidence of AF in the U.S. is approximately 5.1 million - not 2.5 million as previously estimated. Further, since the incidence is increasing, the investigators projected that by 2050 the number of individuals with AF will increase to 12 million (if the rate of new AF does not continue to increase) or approximately 16 million (if the trend continues). The authors also cite several other studies which tend to support their findings and point out that the current estimate of about 2.5 million AF patients was derived from health plan participants which may have led to an underestimate of the prevalence of AF for the entire population.
If their estimate of 5.1 million people with AF in the U.S. is correct and, as several studies have found, about 50% of those do not receive anticoagulation, it would be reasonable to expect that such failure to anticoagulate will produce approximately 125,000 strokes per year (2.5 million x 5%/yr annual stroke incidence = 125,000 strokes/yr). Warfarin anticoagulation has been shown to reduce stroke in AF by approximately 65% (intention to treat analysis) or 83% (on-treatment analysis) which should reduce the 125,000 strokes/yr to approximately 21,000 to 44,000 (based on 83% and 65% reduction, respectively) thereby preventing between 81,000 and 105,000 strokes per year for an annual savings of approximately $8.1 to $10.5 billion (based on $100,000 per stroke).
The investigators suggest that increasing obesity may account for as much as 60% of the increase in the incidence of AF while hypertension and diabetes probably also play a role.
This paper is available online at http://circ.ahajournals.org/cgi/content/full/114/2/119, and a related public discussion of the findings "Epidemic of Deadly Atrial Fibrillation is Here" is available at http://www.forbes.com/forbeslife/health/
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