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Contemporary prevalence estimates of undiagnosed and diagnosed atrial fibrillation in the United States

BACKGROUND: Atrial fibrillation (AF) prevalence estimates vary and have been based on cohorts with clinically established or diagnosed disease. Undiagnosed AF prevalence estimates are less certain as they are based on nongeneralizable convenience samples. HYPOTHESIS: Because AF is often asymptomatic...

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Autores principales: Turakhia, Mintu P., Guo, Jennifer D., Keshishian, Allison, Delinger, Rachel, Sun, Xiaoxi, Ferri, Mauricio, Russ, Cristina, Cato, Matthew, Yuce, Huseyin, Hlavacek, Patrick
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10189075/
https://www.ncbi.nlm.nih.gov/pubmed/36855960
http://dx.doi.org/10.1002/clc.23983
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author Turakhia, Mintu P.
Guo, Jennifer D.
Keshishian, Allison
Delinger, Rachel
Sun, Xiaoxi
Ferri, Mauricio
Russ, Cristina
Cato, Matthew
Yuce, Huseyin
Hlavacek, Patrick
author_facet Turakhia, Mintu P.
Guo, Jennifer D.
Keshishian, Allison
Delinger, Rachel
Sun, Xiaoxi
Ferri, Mauricio
Russ, Cristina
Cato, Matthew
Yuce, Huseyin
Hlavacek, Patrick
author_sort Turakhia, Mintu P.
collection PubMed
description BACKGROUND: Atrial fibrillation (AF) prevalence estimates vary and have been based on cohorts with clinically established or diagnosed disease. Undiagnosed AF prevalence estimates are less certain as they are based on nongeneralizable convenience samples. HYPOTHESIS: Because AF is often asymptomatic, it my remain undiagnosed until the development of complications such as stroke or heart failure. Consequently, the observed prevalence of diagnosed AF from the literature may underestimate total disease burden. We therefore sought to estimate the total prevalence of both diagnosed and undiagnosed AF. METHODS: We performed a retrospective cohort study from 2012 to 2017 using data from five US medical claims data sets. Undiagnosed AF prevalence was estimated based on the observed incidence of ischemic stroke, systemic embolism (SE), and AF incidence after a stroke/SE. The diagnosed AF cohort included AF patients between Q1 2014 and Q3 2015. The undiagnosed AF cohort were patients with assumed undiagnosed AF in the year before a stroke/SE and who were newly diagnosed with AF in the 3‐month poststroke/SE. Stroke/SE incidence was calculated among all AF patients and the ratio of number of undiagnosed AF patients to stroke rate was created. Age‐ and sex‐adjusted estimates were stratified by period of assumed undiagnosed AF before poststroke/SE AF diagnosis (1 or 2 years). RESULTS: The estimated US prevalence of AF (diagnosed and undiagnosed) in Q3 2015 was 5 628 000 cases, of which 591 000 cases (11%) were undiagnosed. The assumed 2‐year undiagnosed AF prevalence was 23% (1 531 000) of the total prevalent patients with AF (6 568 000). Undiagnosed (vs. diagnosed) AF patients were older and had higher CHA2DS2‐VASc scores. Of undiagnosed AF, 93% had CHA2DS2‐VASc ≥2 and met OAC criteria. CONCLUSIONS: These contemporary estimates demonstrate the high prevalence of undiagnosed AF in the United States. Undiagnosed AF patients are composed of primarily elderly individuals who if diagnosed, would meet criteria for stroke prevention therapy.
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spelling pubmed-101890752023-05-18 Contemporary prevalence estimates of undiagnosed and diagnosed atrial fibrillation in the United States Turakhia, Mintu P. Guo, Jennifer D. Keshishian, Allison Delinger, Rachel Sun, Xiaoxi Ferri, Mauricio Russ, Cristina Cato, Matthew Yuce, Huseyin Hlavacek, Patrick Clin Cardiol Clinical Investigations BACKGROUND: Atrial fibrillation (AF) prevalence estimates vary and have been based on cohorts with clinically established or diagnosed disease. Undiagnosed AF prevalence estimates are less certain as they are based on nongeneralizable convenience samples. HYPOTHESIS: Because AF is often asymptomatic, it my remain undiagnosed until the development of complications such as stroke or heart failure. Consequently, the observed prevalence of diagnosed AF from the literature may underestimate total disease burden. We therefore sought to estimate the total prevalence of both diagnosed and undiagnosed AF. METHODS: We performed a retrospective cohort study from 2012 to 2017 using data from five US medical claims data sets. Undiagnosed AF prevalence was estimated based on the observed incidence of ischemic stroke, systemic embolism (SE), and AF incidence after a stroke/SE. The diagnosed AF cohort included AF patients between Q1 2014 and Q3 2015. The undiagnosed AF cohort were patients with assumed undiagnosed AF in the year before a stroke/SE and who were newly diagnosed with AF in the 3‐month poststroke/SE. Stroke/SE incidence was calculated among all AF patients and the ratio of number of undiagnosed AF patients to stroke rate was created. Age‐ and sex‐adjusted estimates were stratified by period of assumed undiagnosed AF before poststroke/SE AF diagnosis (1 or 2 years). RESULTS: The estimated US prevalence of AF (diagnosed and undiagnosed) in Q3 2015 was 5 628 000 cases, of which 591 000 cases (11%) were undiagnosed. The assumed 2‐year undiagnosed AF prevalence was 23% (1 531 000) of the total prevalent patients with AF (6 568 000). Undiagnosed (vs. diagnosed) AF patients were older and had higher CHA2DS2‐VASc scores. Of undiagnosed AF, 93% had CHA2DS2‐VASc ≥2 and met OAC criteria. CONCLUSIONS: These contemporary estimates demonstrate the high prevalence of undiagnosed AF in the United States. Undiagnosed AF patients are composed of primarily elderly individuals who if diagnosed, would meet criteria for stroke prevention therapy. John Wiley and Sons Inc. 2023-03-01 /pmc/articles/PMC10189075/ /pubmed/36855960 http://dx.doi.org/10.1002/clc.23983 Text en © 2023 The Authors. Clinical Cardiology published by Wiley Periodicals, LLC. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Investigations
Turakhia, Mintu P.
Guo, Jennifer D.
Keshishian, Allison
Delinger, Rachel
Sun, Xiaoxi
Ferri, Mauricio
Russ, Cristina
Cato, Matthew
Yuce, Huseyin
Hlavacek, Patrick
Contemporary prevalence estimates of undiagnosed and diagnosed atrial fibrillation in the United States
title Contemporary prevalence estimates of undiagnosed and diagnosed atrial fibrillation in the United States
title_full Contemporary prevalence estimates of undiagnosed and diagnosed atrial fibrillation in the United States
title_fullStr Contemporary prevalence estimates of undiagnosed and diagnosed atrial fibrillation in the United States
title_full_unstemmed Contemporary prevalence estimates of undiagnosed and diagnosed atrial fibrillation in the United States
title_short Contemporary prevalence estimates of undiagnosed and diagnosed atrial fibrillation in the United States
title_sort contemporary prevalence estimates of undiagnosed and diagnosed atrial fibrillation in the united states
topic Clinical Investigations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10189075/
https://www.ncbi.nlm.nih.gov/pubmed/36855960
http://dx.doi.org/10.1002/clc.23983
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