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Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003–2018

Leona A Ritchie Orcid Logo, Stephanie L Harrison Orcid Logo, Peter E Penson Orcid Logo, Ashley Akbari Orcid Logo, Fatemeh Torabi Orcid Logo, Joe Hollinghurst, Daniel Harris, Oluwakayode B Oke, Asangaedem Akpan, Julian Halcox Orcid Logo, Sarah E Rodgers, Gregory Y H Lip, Deirdre A Lane

Age and Ageing, Volume: 51, Issue: 12

Swansea University Authors: Ashley Akbari Orcid Logo, Fatemeh Torabi Orcid Logo, Joe Hollinghurst, Daniel Harris, Julian Halcox Orcid Logo

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DOI (Published version): 10.1093/ageing/afac252

Abstract

ObjectiveTo determine atrial fibrillation (AF) prevalence and temporal trends, and examine associations between AF and risk of adverse health outcomes in older care home residents.MethodsRetrospective cohort study using anonymised linked data from the Secure Anonymised Information Linkage Databank o...

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Published in: Age and Ageing
ISSN: 0002-0729 1468-2834
Published: Oxford University Press (OUP) 2022
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa62133
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Abstract: ObjectiveTo determine atrial fibrillation (AF) prevalence and temporal trends, and examine associations between AF and risk of adverse health outcomes in older care home residents.MethodsRetrospective cohort study using anonymised linked data from the Secure Anonymised Information Linkage Databank on CARE home residents in Wales with AF (SAIL CARE-AF) between 2003 and 2018. Fine-Gray competing risk models were used to estimate the risk of health outcomes with mortality as a competing risk. Cox regression analyses were used to estimate the risk of mortality.ResultsThere were 86,602 older care home residents (median age 86.0 years [interquartile range 80.8–90.6]) who entered a care home between 2003 and 2018. When the pre-care home entry data extraction was standardised, the overall prevalence of AF was 17.4% (95% confidence interval 17.1–17.8) between 2010 and 2018. There was no significant change in the age- and sex-standardised prevalence of AF from 16.8% (15.9–17.9) in 2010 to 17.0% (16.1–18.0) in 2018. Residents with AF had a significantly higher risk of cardiovascular mortality (adjusted hazard ratio [HR] 1.27 [1.17–1.37], P < 0.001), all-cause mortality (adjusted HR 1.14 [1.11–1.17], P < 0.001), ischaemic stroke (adjusted sub-distribution HR 1.55 [1.36–1.76], P < 0.001) and cardiovascular hospitalisation (adjusted sub-distribution HR 1.28 [1.22–1.34], P < 0.001).ConclusionsOlder care home residents with AF have an increased risk of adverse health outcomes, even when higher mortality rates and other confounders are accounted for. This re-iterates the need for appropriate oral anticoagulant prescription and optimal management of cardiovascular co-morbidities, irrespective of frailty status and predicted life expectancy.
Keywords: Atrial fibrillation, stroke, care homes, prevalence, health outcomes, older people
College: Faculty of Medicine, Health and Life Sciences
Funders: This work was supported by Health Data Research UK [HDR-9006], which receives its funding from the UK Medical Research Council; Engineering and Physical Sciences Research Council; Economic and Social Research Council; Department of Health and Social Care (England); Chief Scientist Office of the Scottish Government Health and Social Care Directorates; Health and Social Care Research and Development Division (Welsh Government); Public Health Agency (Northern Ireland); British Heart Foundation (BHF) and the Wellcome Trust and Administrative Data Research UK which is funded by the Economic and Social Research Council [grant ES/S007393/1]. SER is part-funded by the National Institute for Health Research (NIHR) Applied Research Collaboration North West Coast (ARC NWC). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Issue: 12