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Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003–2018

Leona A Ritchie Orcid Logo, Stephanie L Harrison Orcid Logo, Peter E Penson Orcid Logo, Ashley Akbari Orcid Logo, Fatemeh Torabi Orcid Logo, Joe Hollinghurst, Daniel Harris, Oluwakayode B Oke, Asangaedem Akpan, Julian Halcox Orcid Logo, Sarah E Rodgers, Gregory Y H Lip, Deirdre A Lane

Age and Ageing, Volume: 51, Issue: 12

Swansea University Authors: Ashley Akbari Orcid Logo, Fatemeh Torabi Orcid Logo, Joe Hollinghurst, Daniel Harris, Julian Halcox Orcid Logo

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DOI (Published version): 10.1093/ageing/afac252

Abstract

ObjectiveTo determine atrial fibrillation (AF) prevalence and temporal trends, and examine associations between AF and risk of adverse health outcomes in older care home residents.MethodsRetrospective cohort study using anonymised linked data from the Secure Anonymised Information Linkage Databank o...

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Published in: Age and Ageing
ISSN: 0002-0729 1468-2834
Published: Oxford University Press (OUP) 2022
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URI: https://cronfa.swan.ac.uk/Record/cronfa62133
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2023-01-09T10:13:57.2762144</datestamp><bib-version>v2</bib-version><id>62133</id><entry>2022-12-06</entry><title>Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003&#x2013;2018</title><swanseaauthors><author><sid>aa1b025ec0243f708bb5eb0a93d6fb52</sid><ORCID>0000-0003-0814-0801</ORCID><firstname>Ashley</firstname><surname>Akbari</surname><name>Ashley Akbari</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>f569591e1bfb0e405b8091f99fec45d3</sid><ORCID>0000-0002-5853-4625</ORCID><firstname>Fatemeh</firstname><surname>Torabi</surname><name>Fatemeh Torabi</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>d7c51b69270b644a11b904629fe56ab0</sid><firstname>Joe</firstname><surname>Hollinghurst</surname><name>Joe Hollinghurst</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>e60c9c73b645f0e8033ae26fa8e634b8</sid><firstname>Daniel</firstname><surname>Harris</surname><name>Daniel Harris</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>3676f695eeda169d0f8c618adf27c04b</sid><ORCID>0000-0001-6926-2947</ORCID><firstname>Julian</firstname><surname>Halcox</surname><name>Julian Halcox</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2022-12-06</date><deptcode>HDAT</deptcode><abstract>ObjectiveTo determine atrial fibrillation (AF) prevalence and temporal trends, and examine associations between AF and risk of adverse health outcomes in older care home residents.MethodsRetrospective cohort study using anonymised linked data from the Secure Anonymised Information Linkage Databank on CARE home residents in Wales with AF (SAIL CARE-AF) between 2003 and 2018. Fine-Gray competing risk models were used to estimate the risk of health outcomes with mortality as a competing risk. Cox regression analyses were used to estimate the risk of mortality.ResultsThere were 86,602 older care home residents (median age 86.0 years [interquartile range 80.8&#x2013;90.6]) who entered a care home between 2003 and 2018. When the pre-care home entry data extraction was standardised, the overall prevalence of AF was 17.4% (95% confidence interval 17.1&#x2013;17.8) between 2010 and 2018. There was no significant change in the age- and sex-standardised prevalence of AF from 16.8% (15.9&#x2013;17.9) in 2010 to 17.0% (16.1&#x2013;18.0) in 2018. Residents with AF had a significantly higher risk of cardiovascular mortality (adjusted hazard ratio [HR] 1.27 [1.17&#x2013;1.37], P &lt;&#x2009;0.001), all-cause mortality (adjusted HR 1.14 [1.11&#x2013;1.17], P &lt;&#x2009;0.001), ischaemic stroke (adjusted sub-distribution HR 1.55 [1.36&#x2013;1.76], P &lt;&#x2009;0.001) and cardiovascular hospitalisation (adjusted sub-distribution HR 1.28 [1.22&#x2013;1.34], P &lt;&#x2009;0.001).ConclusionsOlder care home residents with AF have an increased risk of adverse health outcomes, even when higher mortality rates and other confounders are accounted for. This re-iterates the need for appropriate oral anticoagulant prescription and optimal management of cardiovascular co-morbidities, irrespective of frailty status and predicted life expectancy.</abstract><type>Journal Article</type><journal>Age and Ageing</journal><volume>51</volume><journalNumber>12</journalNumber><paginationStart/><paginationEnd/><publisher>Oxford University Press (OUP)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0002-0729</issnPrint><issnElectronic>1468-2834</issnElectronic><keywords>Atrial fibrillation, stroke, care homes, prevalence, health outcomes, older people</keywords><publishedDay>5</publishedDay><publishedMonth>12</publishedMonth><publishedYear>2022</publishedYear><publishedDate>2022-12-05</publishedDate><doi>10.1093/ageing/afac252</doi><url/><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>This work was supported by Health Data Research UK [HDR-9006], which receives its funding from the UK Medical Research Council; Engineering and Physical Sciences Research Council; Economic and Social Research Council; Department of Health and Social Care (England); Chief Scientist Office of the Scottish Government Health and Social Care Directorates; Health and Social Care Research and Development Division (Welsh Government); Public Health Agency (Northern Ireland); British Heart Foundation (BHF) and the Wellcome Trust and Administrative Data Research UK which is funded by the Economic and Social Research Council [grant ES/S007393/1]. SER is part-funded by the National Institute for Health Research (NIHR) Applied Research Collaboration North West Coast (ARC NWC). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.</funders><projectreference/><lastEdited>2023-01-09T10:13:57.2762144</lastEdited><Created>2022-12-06T17:42:08.2322679</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Leona A</firstname><surname>Ritchie</surname><orcid>0000-0002-0392-1767</orcid><order>1</order></author><author><firstname>Stephanie L</firstname><surname>Harrison</surname><orcid>0000-0002-8846-0946</orcid><order>2</order></author><author><firstname>Peter E</firstname><surname>Penson</surname><orcid>0000-0001-6763-1489</orcid><order>3</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>4</order></author><author><firstname>Fatemeh</firstname><surname>Torabi</surname><orcid>0000-0002-5853-4625</orcid><order>5</order></author><author><firstname>Joe</firstname><surname>Hollinghurst</surname><order>6</order></author><author><firstname>Daniel</firstname><surname>Harris</surname><order>7</order></author><author><firstname>Oluwakayode B</firstname><surname>Oke</surname><order>8</order></author><author><firstname>Asangaedem</firstname><surname>Akpan</surname><order>9</order></author><author><firstname>Julian</firstname><surname>Halcox</surname><orcid>0000-0001-6926-2947</orcid><order>10</order></author><author><firstname>Sarah E</firstname><surname>Rodgers</surname><order>11</order></author><author><firstname>Gregory Y H</firstname><surname>Lip</surname><order>12</order></author><author><firstname>Deirdre A</firstname><surname>Lane</surname><order>13</order></author></authors><documents><document><filename>62133__26207__1170bde3e8cf4231b0d8428b48a9192a.pdf</filename><originalFilename>62133.pdf</originalFilename><uploaded>2023-01-09T09:57:43.3831851</uploaded><type>Output</type><contentLength>622788</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; The Author(s) 2022. This is an Open Access ar ticle distributed under the terms of the Creative Commons Attribution License</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>https://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2023-01-09T10:13:57.2762144 v2 62133 2022-12-06 Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003–2018 aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false f569591e1bfb0e405b8091f99fec45d3 0000-0002-5853-4625 Fatemeh Torabi Fatemeh Torabi true false d7c51b69270b644a11b904629fe56ab0 Joe Hollinghurst Joe Hollinghurst true false e60c9c73b645f0e8033ae26fa8e634b8 Daniel Harris Daniel Harris true false 3676f695eeda169d0f8c618adf27c04b 0000-0001-6926-2947 Julian Halcox Julian Halcox true false 2022-12-06 HDAT ObjectiveTo determine atrial fibrillation (AF) prevalence and temporal trends, and examine associations between AF and risk of adverse health outcomes in older care home residents.MethodsRetrospective cohort study using anonymised linked data from the Secure Anonymised Information Linkage Databank on CARE home residents in Wales with AF (SAIL CARE-AF) between 2003 and 2018. Fine-Gray competing risk models were used to estimate the risk of health outcomes with mortality as a competing risk. Cox regression analyses were used to estimate the risk of mortality.ResultsThere were 86,602 older care home residents (median age 86.0 years [interquartile range 80.8–90.6]) who entered a care home between 2003 and 2018. When the pre-care home entry data extraction was standardised, the overall prevalence of AF was 17.4% (95% confidence interval 17.1–17.8) between 2010 and 2018. There was no significant change in the age- and sex-standardised prevalence of AF from 16.8% (15.9–17.9) in 2010 to 17.0% (16.1–18.0) in 2018. Residents with AF had a significantly higher risk of cardiovascular mortality (adjusted hazard ratio [HR] 1.27 [1.17–1.37], P < 0.001), all-cause mortality (adjusted HR 1.14 [1.11–1.17], P < 0.001), ischaemic stroke (adjusted sub-distribution HR 1.55 [1.36–1.76], P < 0.001) and cardiovascular hospitalisation (adjusted sub-distribution HR 1.28 [1.22–1.34], P < 0.001).ConclusionsOlder care home residents with AF have an increased risk of adverse health outcomes, even when higher mortality rates and other confounders are accounted for. This re-iterates the need for appropriate oral anticoagulant prescription and optimal management of cardiovascular co-morbidities, irrespective of frailty status and predicted life expectancy. Journal Article Age and Ageing 51 12 Oxford University Press (OUP) 0002-0729 1468-2834 Atrial fibrillation, stroke, care homes, prevalence, health outcomes, older people 5 12 2022 2022-12-05 10.1093/ageing/afac252 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University Another institution paid the OA fee This work was supported by Health Data Research UK [HDR-9006], which receives its funding from the UK Medical Research Council; Engineering and Physical Sciences Research Council; Economic and Social Research Council; Department of Health and Social Care (England); Chief Scientist Office of the Scottish Government Health and Social Care Directorates; Health and Social Care Research and Development Division (Welsh Government); Public Health Agency (Northern Ireland); British Heart Foundation (BHF) and the Wellcome Trust and Administrative Data Research UK which is funded by the Economic and Social Research Council [grant ES/S007393/1]. SER is part-funded by the National Institute for Health Research (NIHR) Applied Research Collaboration North West Coast (ARC NWC). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. 2023-01-09T10:13:57.2762144 2022-12-06T17:42:08.2322679 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Leona A Ritchie 0000-0002-0392-1767 1 Stephanie L Harrison 0000-0002-8846-0946 2 Peter E Penson 0000-0001-6763-1489 3 Ashley Akbari 0000-0003-0814-0801 4 Fatemeh Torabi 0000-0002-5853-4625 5 Joe Hollinghurst 6 Daniel Harris 7 Oluwakayode B Oke 8 Asangaedem Akpan 9 Julian Halcox 0000-0001-6926-2947 10 Sarah E Rodgers 11 Gregory Y H Lip 12 Deirdre A Lane 13 62133__26207__1170bde3e8cf4231b0d8428b48a9192a.pdf 62133.pdf 2023-01-09T09:57:43.3831851 Output 622788 application/pdf Version of Record true © The Author(s) 2022. This is an Open Access ar ticle distributed under the terms of the Creative Commons Attribution License true eng https://creativecommons.org/licenses/by/4.0/
title Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003–2018
spellingShingle Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003–2018
Ashley Akbari
Fatemeh Torabi
Joe Hollinghurst
Daniel Harris
Julian Halcox
title_short Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003–2018
title_full Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003–2018
title_fullStr Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003–2018
title_full_unstemmed Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003–2018
title_sort Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003–2018
author_id_str_mv aa1b025ec0243f708bb5eb0a93d6fb52
f569591e1bfb0e405b8091f99fec45d3
d7c51b69270b644a11b904629fe56ab0
e60c9c73b645f0e8033ae26fa8e634b8
3676f695eeda169d0f8c618adf27c04b
author_id_fullname_str_mv aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
f569591e1bfb0e405b8091f99fec45d3_***_Fatemeh Torabi
d7c51b69270b644a11b904629fe56ab0_***_Joe Hollinghurst
e60c9c73b645f0e8033ae26fa8e634b8_***_Daniel Harris
3676f695eeda169d0f8c618adf27c04b_***_Julian Halcox
author Ashley Akbari
Fatemeh Torabi
Joe Hollinghurst
Daniel Harris
Julian Halcox
author2 Leona A Ritchie
Stephanie L Harrison
Peter E Penson
Ashley Akbari
Fatemeh Torabi
Joe Hollinghurst
Daniel Harris
Oluwakayode B Oke
Asangaedem Akpan
Julian Halcox
Sarah E Rodgers
Gregory Y H Lip
Deirdre A Lane
format Journal article
container_title Age and Ageing
container_volume 51
container_issue 12
publishDate 2022
institution Swansea University
issn 0002-0729
1468-2834
doi_str_mv 10.1093/ageing/afac252
publisher Oxford University Press (OUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description ObjectiveTo determine atrial fibrillation (AF) prevalence and temporal trends, and examine associations between AF and risk of adverse health outcomes in older care home residents.MethodsRetrospective cohort study using anonymised linked data from the Secure Anonymised Information Linkage Databank on CARE home residents in Wales with AF (SAIL CARE-AF) between 2003 and 2018. Fine-Gray competing risk models were used to estimate the risk of health outcomes with mortality as a competing risk. Cox regression analyses were used to estimate the risk of mortality.ResultsThere were 86,602 older care home residents (median age 86.0 years [interquartile range 80.8–90.6]) who entered a care home between 2003 and 2018. When the pre-care home entry data extraction was standardised, the overall prevalence of AF was 17.4% (95% confidence interval 17.1–17.8) between 2010 and 2018. There was no significant change in the age- and sex-standardised prevalence of AF from 16.8% (15.9–17.9) in 2010 to 17.0% (16.1–18.0) in 2018. Residents with AF had a significantly higher risk of cardiovascular mortality (adjusted hazard ratio [HR] 1.27 [1.17–1.37], P < 0.001), all-cause mortality (adjusted HR 1.14 [1.11–1.17], P < 0.001), ischaemic stroke (adjusted sub-distribution HR 1.55 [1.36–1.76], P < 0.001) and cardiovascular hospitalisation (adjusted sub-distribution HR 1.28 [1.22–1.34], P < 0.001).ConclusionsOlder care home residents with AF have an increased risk of adverse health outcomes, even when higher mortality rates and other confounders are accounted for. This re-iterates the need for appropriate oral anticoagulant prescription and optimal management of cardiovascular co-morbidities, irrespective of frailty status and predicted life expectancy.
published_date 2022-12-05T04:21:31Z
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score 11.012678

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