Incidence, management and outcomes of patients with incident atrial fibrillation in the contemporary direct oral anti coagulants era. A national study

Most of the epidemiological data regarding AF originates from population studies in north America and Europe. Previous studies demonstrated different prevalence and clinical outcomes of AF a in different ethnic groups. There are scarce data regarding AF epidemiology, management and outcome in the current era of wider use of the direct oral anticoagulants (DOAC) and early rhythm control strategies.

To describe the prevalence, incidence, as well as management and outcomes of AF patients in the last decade.

Patients with incident AF aged 18 years old or older were included in this study from January 1st, 2012, to December 31st 2022. All the data and diagnoses were extracted from electronic medical records a using a large data sharing platform powered by MD Clone. Patients with congenital heart disease, rheumatic heart disease, prosthetic valves and significant (>moderate) mitral stenosis, were excluded. The primary outcomes that were systemically collected were all cause death, ischemic stroke, and the combined endpoint of death, and ischemic stroke. The median follow-up time was 52 months.

A total number of 79,215 were included in the study, among them, 39,995 Females (50.5%). The mean age was 73. The most common comorbid conditions were hypertension, diabetes mellitus and vascular disease. The incidence of AF was directly related to age and was higher in males across all age groups.

Rhythm control antiarrhythmic therapy that used was Amiodarone (11%), Propafenone (6.1%) and Flecainide (3.3%). DOACS were used in 47% and Warfarin was used in 13%. The rate of anticoagulant therapy, within 3 months after index diagnosis among 68,285 patients with CHA₂DS₂ VASC >2 was 60%.

Independent risk factors for ischemic stroke were previous stroke, diabetes mellitus, current smoking, heart failure and hypertension. The risk of ischemic stroke was directly related to age and CHA₂DS₂ VASC score. Similar rates of stroke were demonstrated for men and women at different CHA₂DS₂ VASC score, except a slightly higher rate of stroke among men with moderate thrombotic risk (Figures 1a,1b and 1c).

Independent risk factors for death were heart failure, current smoking status, previous stroke and Diabetes Mellitus. The risk of death was directly related to age and risk of CHA₂DS₂ VASC score risk (Figures 2a and 2b).

The rate of early treatment with anticoagulant therapy in this study population is higher than previously reported rates, with increasing use of DOAC therapy and decreasing rates of Warfarin therapy. Nevertheless, the incidence rate of stroke and death are only mildly lower compared to previous reported rates.

In addition, we did not observe a significant difference in ischemic stroke rates between men and women.