Arrhythmias and conduction disturbances
Estimates of Current and Future Incidence and Prevalence of Atrial Fibrillation in the U.S. Adult Population

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Estimates and projections of diagnosed incidence and prevalence of atrial fibrillation (AF) in the United States have been highly inconsistent across published studies. Although it is generally acknowledged that AF incidence and prevalence are increasing due to growing numbers of older people in the U.S. population, estimates of the rate of expected growth have varied widely. Reasons for these variations include differences in study design, covered time period, birth cohort, and temporal effects, as well as improvements in AF diagnosis due to increased use of diagnostic tools and health care awareness. The objective of this study was to estimate and project the incidence and prevalence of diagnosed AF in the United States out to 2030. A large health insurance claims database for the years 2001 to 2008, representing a geographically diverse 5% of the U.S. population, was used in this study. The trend and growth rate in AF incidence and prevalence was projected by a dynamic age-period cohort simulation progression model that included all diagnosed AF cases in future prevalence projections regardless of follow-up treatment, as well as those cases expected to be chronic in nature. Results from the model showed that AF incidence will double, from 1.2 million cases in 2010 to 2.6 million cases in 2030. Given this increase in incidence, AF prevalence is projected to increase from 5.2 million in 2010 to 12.1 million cases in 2030. The effect of uncertainty in model parameters was explored in deterministic and probabilistic sensitivity analyses. Variability in future trends in AF incidence and recurrence rates has the greatest impact on the projected estimates of chronic AF prevalence. It can be concluded that both incidence and prevalence of AF are likely to rise from 2010 to 2030, but there exists a wide range of uncertainty around the magnitude of future trends.

Section snippets

Methods

We developed a retrospective study using the medical, pharmacy, and enrollment information in the I3/Innovus health insurance claims database from January 1, 2001, through June 30, 2008. This database included more than 14 million individuals who were enrolled in large, commercial, or Medicare Advantage health plans and represented a geographically diverse 5% of the U.S. population.

Annual incidence is defined as the rate of acquiring a new AF diagnosis in the health claims data within a 1-year

Results

In 2007, 8,749 incident AF cases met our diagnostic criteria for newly diagnosed AF cases in this health insurance claims database. The age- and gender-adjusted AF incidence rate, standardized to the general U.S. population, grew from approximately 220 per 100,000 in 2002 to about 350 per 100,000 in 2007 (Figure 1), corresponding to a 9.2% annual growth rate. Accordingly, when these incidence rates are applied to the 2000 U.S. census population estimates, approximately 660,000 incident cases of

Discussion

This current study uses the largest and most geographically diverse U.S. population sample to estimate current and future AF incidence and prevalence. The projected increase in AF prevalence is not simply a result of increasing numbers of older people but also reflects the empirical fact that the incidence rate of AF is increasing. Both age-adjusted incidence and prevalence increased over the observed study period of 2001 to 2007. Assuming the 2000 U.S. Census population projections and that

Acknowledgment

We thank Irene Durham of Bristol-Myers Squibb for providing medical writing and formatting support for this article.

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This study was supported by a grant from Bristol-Myers Squibb and Pfizer Inc.

See page 1146 for disclosure information.

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