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Incidence of AF increased in older patients initiating dialysis
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The incidence of atrial fibrillation increased in a US population of older patients initiating dialysis, according to results of a 13-year study recently published in Circulation.
Researchers identified 258,605 patients aged at least 67 years with fee-for-service Medicare. All patients were initiating dialysis in 1995 to 2007, and had no previous diagnosis of AF within the previous 2 years. Patients were followed for newly diagnosed AF for 13 years.
Researchers also examined temporal trends and associations of race and ethnicity with incident AF using multivariable proportional hazards regression and temporal trends in the mortality and risk for ischemic stroke after newly diagnosed AF.
During 514,395 person-years of follow-up, 76,252 patients experienced incident AF at a crude incidence rate of 148 per 1,000 person-years. Data showed that the incidence of AF increased by 11% (95% CI, 5-16) from 1995 to 2007. African Americans (–30%), Asians (–19%), Native Americans (–42%) and Hispanics (–29%) all had lower rates of incident AF compared with non-Hispanic whites. A decrease of 22% in mortality after incident AF was also seen from 1995 to 2008. Reductions in incident ischemic stroke were even more pronounced during this period.
“The incidence of AF is high in older patients initiating dialysis in the US and has been increasing over the 13 years of study. Mortality declined during that time, but remained greater than 50% during the first year after newly diagnosed AF. Since 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,” the study researchers concluded.
“Identifying and testing any strategies to reduce incident AF in patients on dialysis could have a large public health impact in this vulnerable population,” the study researchers wrote.
Disclosure: This work was supported by grants from the National Institute of Diabetes, Digestive, and Kidney Diseases to Winkelmayer. Arce was supported by an underrepresented minority supplement (URM) to grant T32DK007357-26. Turakhia has received investigator-initiated grant support from the Department of Veterans Affairs and the American Heart Association. Turakhia has served as a consultant to Boston Scientific and Precision Health Economics LLC. All other researchers report no relevant financial disclosures.
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