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Clinical Effectiveness Group

Half as many AF patients dying of heart attacks and strokes

New research finds patients living with atrial fibrillation - one of the UK’s most common heart rhythm conditions - are 50% less likely to die from a heart attack or stroke than they were at the start of the millennium, but there are significant health inequalities between richest and poorest.


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

AF is associated with an increased risk of stroke. But the research showed that dementia now 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 findings also reveal significant health inequalities, showing that the most socioeconomically deprived patients were 22% 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. 

Lead author Jianhua Wu, Professor of Biostatistics and Health Data Science at CEG, said:

“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.” 

Data analysis 

Researchers examined data from the electronic health records of 72,412 patients who had been diagnosed with AF between 2001 and 2017, from a representative sample of the UK population using Clinical Practice Research Datalink (CPRD). 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. 

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

Cardiovascular deaths declined from 7.3% in 2001/02 to 3% in 2016/2017, while cerebrovascular (stroke) deaths declined from 2.6% to 1.1%. 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% in 2001/02 to 10.1% in 2016/17. Of these deaths, 87.2% 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. 

Other findings include: 

  • Hospitalisation is common within a year of AF diagnosis, with almost two further admissions experienced by patients
  • Hospitalisation rates have increased by 17% due to increasing admissions from non-cardio/cerebrovascular causes, especially in older patients
  • Hospitalisation for cardiovascular and cerebrovascular causes have decreased by 38% and 28%, respectively, but for non-cardio/cerebrovascular causes hospitalisation has increased by 42%
  • Older people have experienced the greatest rise in hospitalisation, with those aged 80 years or more experiencing a 39% rise in hospitalisation within a year of AF diagnosis 

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 said:

“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.” 

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