Prevalence/incidence of atrial fibrillation based on integrated medical/pharmacy claims, and association with co-morbidity profiles/multi-morbidity in a large US adult cohort.

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. Accurate, population-level data that can enable the ongoing monitoring of AF epidemiology, quality of care at affordable cost, and complications are needed. We hypothesised that prevalent/incidence data would vary via the use of integrated medical/pharmacy claims, and associated comorbidities would vary accordingly. 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 integrated criteria from both medical/pharmacy claims. METHODS: We studied a population of 8 343 992 persons across many geographical areas in the US continent from 1 January/2016 to 31 October 2019. The prevalence and incidence of AF were comparatively analysed for different healthcare parameters (eg, emergency room visit, anticoagulant medication, heart rhythm control medication) and for integrated criteria based on medical/pharmacy claims. 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 gender. The proportion with multi-morbidity (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%. Multi-morbidity is common amongst AF patients, affecting approximately 1 in 10 patients. AF patients with four or more co-morbidities captured 20%-40% of the AF cohorts depending on age groups and prevalent or incident cases.