• Morten Schmidt, Sinna Pilgaard Ulrichsen, Lars Pedersen, Hans Erik Bøtker, Nielsen Jens Cosedis JC Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark., and Henrik Toft Sørensen.
• Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Internal Medicine, Regional Hospital of Randers, Denmark. Electronic address: morten.schmidt@clin.au.dk.
• Int. J. Cardiol. 2016 Dec 15; 225: 30-36.

BackgroundLong-term nationwide trends in atrial fibrillation (AF) incidence and 5-year outcomes are rare.MethodsWe conducted a population-based cohort study using the Danish National Patient Registry covering all Danish hospitals. We computed standardized incidence rates during 1983-2012. We used Cox regression to estimate hazard ratios (HRs) of heart failure, stroke, and death within 5years, comparing 5-year calendar periods with the earliest period (1983-1987) as reference.ResultsWe identified 312,420 patients with first-time hospital-diagnosed AF. The incidence rate per 100,000person-years increased from 98 in 1983 to 307 in 2012. The mean annual increase during the 30-year study period was 4%, with a 6% increase annually until 2000 and a 1.4% increase annually thereafter. The incidence trends were most pronounced among men and persons above 70years. Among high-risk subgroups, AF incidence was consistently highest in patients with valvular heart disease or heart failure. The rate of heart failure following AF declined by 50% over the entire study period (HR: 0.49, 95% confidence interval (CI): 0.48-0.51) and the mortality rate declined by 40% (HR: 0.62, 95% CI: 0.61-0.63). Within the last two decades, the rate for ischemic stroke declined by 20% (HR 0.81, 95% CI: 0.78-0.84), but increased almost as much for haemorrhagic stroke (HR: 1.14, 95% CI: 1.01-1.29).ConclusionsThe long-term risk of heart failure, ischemic stroke, and death following onset of AF has decreased remarkably over the last three decades. Still, the threefold increased incidence of hospital-diagnosed AF during the same period is a major public health concern.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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