Document Detail


Trends in the incidence of atrial fibrillation in older patients initiating dialysis in the United States.
MedLine Citation:
PMID:  23032326     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: One sixth of US dialysis patients 65 years of age 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 of age) with fee-for-service Medicare initiating dialysis in 1995 to 2007, who had not been diagnosed with AF within the previous 2 years. Patients were followed for newly diagnosed AF. Multivariable proportional hazard 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 148/1000 person-years. Incidence of AF increased by 11% (95% confidence interval, 5-16) from 1995 to 2007. Compared with non-Hispanic whites, blacks (-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 to 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 United States 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. Because data on warfarin use were not available, we were unable to study whether trends toward better outcomes could be explained by higher rates of oral anticoagulation.
Authors:
Benjamin A Goldstein; Cristina M Arce; Mark A Hlatky; Mintu Turakhia; Soko Setoguchi; Wolfgang C Winkelmayer
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2012-10-02
Journal Detail:
Title:  Circulation     Volume:  126     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-06     Completed Date:  2013-01-14     Revised Date:  2014-05-01    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2293-301     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Atrial Fibrillation / epidemiology*,  ethnology*
Cohort Studies
Continental Population Groups / ethnology
Female
Follow-Up Studies
Humans
Incidence
Kidney Failure, Chronic / ethnology*,  therapy*
Longitudinal Studies
Male
Medicare
Multivariate Analysis
Renal Dialysis*
Retrospective Studies
Stroke / epidemiology
United States / epidemiology
Grant Support
ID/Acronym/Agency:
1R01DK095024/DK/NIDDK NIH HHS; 1R21DK077336/DK/NIDDK NIH HHS; R01 DK095024/DK/NIDDK NIH HHS; R21 DK077336/DK/NIDDK NIH HHS; T32 DK007357/DK/NIDDK NIH HHS; T32DK007357-26/DK/NIDDK NIH HHS
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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