Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(5), 484–493. https://doi.org/10.1002/clc.23983 Dr. Mintu P. Turakhia et al.
Points
- Atrial fibrillation (AF) is a common cardiac condition, often undiagnosed due to its asymptomatic nature until complications such as stroke or heart failure arise.
- A retrospective cohort study using US medical claims data sets from 2012 to 2017 estimated the prevalence of diagnosed and undiagnosed AF.
- The estimated US prevalence of AF in Q3 2015 was 5,628,000 cases, with 11% (591,000 cases) being undiagnosed AF.
- Undiagnosed AF patients were typically older and had higher CHA2DS2-VASc scores, indicating a greater risk of stroke. Remarkably, 93% of undiagnosed AF cases met the criteria for oral anticoagulation therapy.
- Early detection and intervention in undiagnosed AF cases are crucial to prevent strokes and related complications, given the high prevalence of undiagnosed AF, particularly among older individuals.
Summary
Atrial fibrillation (AF), a common cardiac arrhythmia, poses a significant health burden, with its prevalence typically determined from clinically diagnosed cases. However, undiagnosed AF cases remain a concealed concern as they often lack noticeable symptoms until complications such as stroke or heart failure arise. This study aimed to estimate AF prevalence, encompassing diagnosed and undiagnosed cases comprehensively.
To accomplish this, a retrospective cohort study was conducted from 2012 to 2017, utilizing data from five US medical claims databases. Undiagnosed AF prevalence was inferred through the analysis of ischemic stroke and systemic embolism (SE) incidence, along with AF incidence after stroke/SE events. The diagnosed AF group encompassed patients diagnosed between Q1 2014 and Q3 2015, while the undiagnosed AF group included individuals with presumed undiagnosed AF in the year before a stroke/SE event, later diagnosed with AF within three months post-event. Stroke/SE incidence was assessed across all AF patients, creating a ratio between the number of undiagnosed AF cases and the stroke rate. The duration of presumed undiagnosed AF further stratified age and sex-adjusted estimates before the post-stroke/SE AF diagnosis (1 or 2 years).
The findings revealed that the estimated prevalence of AF in the United States in Q3 2015 was approximately 5,628,000 cases, among which 591,000 cases (11%) were undiagnosed. Notably, the assumed 2-year undiagnosed AF prevalence accounted for 23% (1,531,000) of the total AF cases. Undiagnosed AF patients were predominantly older individuals with higher CHA2DS2-VASc scores, indicating an elevated risk of stroke. Strikingly, 93% of undiagnosed AF cases met the criteria for oral anticoagulation therapy, highlighting the significance of identifying these individuals to prevent stroke.
In conclusion, this research underscores the substantial prevalence of undiagnosed AF in the United States, particularly among older individuals at risk of stroke. The study emphasizes the importance of early detection and intervention in undiagnosed AF cases to mitigate the risk of stroke and associated complications.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.23983
References Turakhia, M. P., Guo, J. D., Keshishian, A., Delinger, R., Sun, X., Ferri, M., Russ, C., Cato, M., Yuce, H., & Hlavacek, P. (2023). Contemporary prevalence estimates of undiagnosed and diagnosed atrial fibrillation in the United States. Clinical Cardiology, 46(5), 484–493. https://doi.org/10.1002/clc.23983
