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Half as many atrial fibrillation patients dying of strokes in the UK



New research claims that those living with atrial fibrillation in the UK are 50 per cent less likely to die from a heart attack or stroke than they were at the start of the millennium.

By analysing the health records of over 70,000 patients newly diagnosed with atrial fibrillation (AF), this research showed that mortality from related cardiovascular and cerebrovascular diseases more than halved over the 16-year study period.

The research, from a team at the University of Leeds, proved that dementia accounts for more deaths within one year of an AF diagnosis than acute stroke, heart attack and heart failure combined, demonstrating the need for more research into the link between dementia and AF.

The team behind this research believe the lower mortality rate is due to better detection and treatment for AF, which, according to the British Heart Foundation, affects more than 1.5 million people in the UK.

However, the findings reveal significant health inequalities, displaying that the most socioeconomically deprived patients were 22 per cent more likely to die from AF-related conditions than people from the most affluent group.

Additionally, patients are now more likely to be diagnosed with coexisting health conditions such as diabetes, cancer and chronic kidney disease, which have greater health implications for them than AF.

Senior author Chris Gale, Professor of Cardiovascular Medicine, Honorary Consultant Cardiologist, and Co-Director of the Leeds Institute for Data Analytics at the University of Leeds says: “Atrial fibrillation is a common and often undetected heart rhythm disorder that increases the risk of stroke. Advances in health care have now reduced the chance of having a stroke related to AF, and from dying as result of it, if AF is detected and treated.

“However, our study also reveals important disparities in care associated with deprivation and the co-existence of other illnesses. Proactively diagnosing and treating AF in these groups will likely further reduce death and disability from cardiovascular disease. Equally, for many people, AF is a marker of co-existent disease – identifying and treating these additional disease states could further improve outcome for people with AF.”

The research team is now demanding randomised clinical trials to determine whether the earlier identification and treatment of AF and associated co-morbidities could effectively improve cardiovascular health.

Data analysis

This research analysed data from electronic health records of 72,412 patients from a representative sample of the UK population, who had been diagnosed with AF between 2001 and 2017. The team assessed the health outcomes in patients in the first year after their AF diagnosis, and analysed changes in cause-specific mortality and hospitalisation over time and by sex, age, socioeconomic status and diagnostic care setting.

The average patient was aged 75.6. 48.2 per cent of patients were women, and 61.8 per cent had three or more comorbidities.

Over the study period, coexisting health concerns became more common, with almost 70 per cent of newly diagnosed AF patients also having at least three comorbidities.

Mortality rates at one year post diagnosis and the number of hospital admissions with an overnight stay within 1 year of diagnosis were both investigated.

Over the study period, 20 per cent of patients died from any cause within a year of being diagnosed with AF – but this declined over time.

However, the researchers found that deaths due to cardiovascular and cerebrovascular events (strokes) more than halved over the study period. Cardiovascular deaths declined from 7.3 per cent in 2001/02 to 3 per cent in 2016/2017, while cerebrovascular deaths declined from 2.6 per cent to 1.1 per cent.

The researchers say that the lower rates of cardiovascular deaths among AF patients in the study may be partly explained by improvements in strategies to prevent heart disease, and by changes in clinical practice that could lead to people being diagnosed earlier.

By contrast, there was an increase in mortality rates from mental and neurological disorders, from 2.5 per cent in 2001/02 to 10.1 per cent in 2016/17. Of these deaths, 87.2 per cent were caused by dementia, Alzheimer’s disease and Parkinson’s disease. The research team say that while this could be partly due to greater awareness of dementia, it also strengthens the evidence that the relationship between AF and dementia is a pressing research priority.

Health inequalities

Professor Gale says: “Patients diagnosed in hospital or from the most deprived group had worse outcomes compared with those diagnosed in the community or from the most affluent group.

“Although increased burden of comorbidities might partly explain the increased frequency of death in these groups, the persisting difference after full adjustment for these factors suggests other social and health-care factors might also contribute.

“Our previous research showed that the most deprived individuals in the UK experience an AF diagnosis at a younger age than the most affluent individuals. This discrepancy in outcomes warrants targeted strategies and healthcare resource planning.”

Lead author Jianhua Wu, Professor of Biostatistics and Health Data Science in the Queen Mary University of London’s Wolfson Institute of Population Health says: “AF is one of the most prevalent heart conditions in the UK and as such it is crucial that we understand whether or not the current management of the condition is successful. Our findings provide vital evidence about the effectiveness of treatments for this condition, while also showing that other conditions are becoming more prevalent among AF patients – potentially providing avenues for exploration of more targeted treatments.”