Evolving changes of outcomes in patients with newly diagnosed atrial fibrillation: a nationwide study
Authors: Fauchier L , Bentounes S , Bisson A , Bodin A , Herbert J , Chao TF , Lip GYH 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background and aims. The integrated approach for management of atrial fibrillation (AF) has been proposed in recent years for reducing AF-related mortality, morbidity, and hospitalizations. We evaluated the trends in the risk of ischemic stroke, intracranial bleeding, hospitalization for heart failure, cardiovascular mortality and all-cause death among newly diagnosed patients with AF in a nationwide cohort study since 2010.

Methods
This French longitudinal cohort study was based on the national hospitalization database covering hospital care from for the entire population. All adults hospitalized in French hospitals with AF from January 1, 2010 to December 31, 2018, were identified. Among them, 1,938,269 newly diagnosed patients with AF who survived 60 days after AF was diagnosed were included in the analysis. The 1-year risk of ischemic stroke, intracranial bleeding, and mortality of patients with AF diagnosed in each year were compared to those diagnosed in 2010 using the logistic regression analysis adjusted for age, sex, hypertension, diabetes mellitus, heart failure, prior stroke, vascular diseases, chronic obstructive pulmonary disease, hyperlipidemia, inflammatory diseases, cancer, abnormal renal function, abnormal liver function, anemia, and history of bleeding.

Results
The age of newly diagnosed patients with AF was stable from 77.1±11.8 years in 2010 to 76.9±12.6 years in 2018. Mean CHA2DS2-VASc scores of patients with incident AF showed a significant increasing trend for each year (from 3.32 in 2010 to 3.54 in 2018, p&lt;0.001).
Temporal trends for the risk of adverse events at 1-year follow-up in newly diagnosed patients with AF compared to 2010 are shown in the Figure. Compared with 2010, the risk of ischemic stroke was significantly lower in all subsequent years from 2011 to 2018 (adjusted hazard ratios [HR] 0.940 to 0.854; p ranging from p=0.001 to &lt;0.0001). The risk of major bleeding was significantly lower in all subsequent years after 2010 (adjusted HRs 0.965 to 0.621; p ranging from p=0.002 to &lt;0.0001). By contrast, the risk of intracranial bleeding was not different after 2010 (adjusted HRs 1.032 to 0.996; all p&gt;0.50). The risk of hospitalization for heart failure was significantly lower in all subsequent years after 2010 (adjusted HRs 0.927 to 0.820; all p&lt;0.0001). Finally, the risk of cardiovascular mortality and all-cause death were also significantly lower after 2010 (adjusted HRs 0.952 to 0.690; p ranging from p=0.001 to &lt;0.0001 and adjusted HRs 0.948 to 0.715; all p&lt;0.0001 respectively).

Conclusion
We observed a constant reduction in the risk of ischemic stroke, major bleeding, hospitalization for HF, cardiovascular death and all-cause death in AF patients seen in French hospitals in recent years. This may be related to an increasing use of oral anticoagulants (including NOACs) and by a more holistic and integrated approach to AF management that has been proposed in the more recent guidelines.