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

doi:10.1093/ageing/afac252

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

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Abstract

Objective: To determine atrial fibrillation (AF) prevalence and temporal trends, and examine associations between AF and risk of adverse health outcomes in older care home residents.

Methods: Retrospective 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.

Results: There 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).

Conclusions: Older 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.

Original language	English
Article number	afac252
Number of pages	10
Journal	Age and Ageing
Volume	51
Issue number	12
DOIs	https://doi.org/10.1093/ageing/afac252
Publication status	Published - Dec 2022
Externally published	Yes

Keywords

Atrial fibrillation
care homes
health outcomes
older people
prevalence
stroke

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/ageing/afac252Licence: CC BY

Final published versionFinal published version, 482 KBLicence: CC BY

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Ritchie, L. A., Harrison, S. L., Penson, P. E., Akbari, A., Torabi, F., Hollinghurst, J., Harris, D., Oke, O. B., Akpan, A., Halcox, J. P., Rodgers, S. E., Lip, G. Y. H., & Lane, D. A. (2022). Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: A routine data linkage study 2003-2018. Age and Ageing, 51(12), Article afac252. https://doi.org/10.1093/ageing/afac252

@article{b03f00dc569047cc9f7228869ce86a80,

title = "Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: A routine data linkage study 2003-2018",

abstract = "Objective: To determine atrial fibrillation (AF) prevalence and temporal trends, and examine associations between AF and risk of adverse health outcomes in older care home residents. Methods: Retrospective 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. Results: There 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). Conclusions: Older 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.",

keywords = "Atrial fibrillation, care homes, health outcomes, older people, prevalence, stroke",

author = "Ritchie, {Leona A} and Harrison, {Stephanie L} and Penson, {Peter E} and Ashley Akbari and Fatemeh Torabi and Joe Hollinghurst and Daniel Harris and Oke, {Oluwakayode B} and Asangaedem Akpan and Halcox, {Julian P} and Rodgers, {Sarah E} and Lip, {Gregory Y H} and Lane, {Deirdre A}",

year = "2022",

month = dec,

doi = "10.1093/ageing/afac252",

language = "English",

volume = "51",

journal = "Age and Ageing",

issn = "0002-0729",

publisher = "Oxford University Press",

number = "12",

}

Ritchie, LA, Harrison, SL, Penson, PE, Akbari, A, Torabi, F, Hollinghurst, J, Harris, D, Oke, OB, Akpan, A, Halcox, JP, Rodgers, SE, Lip, GYH & Lane, DA 2022, 'Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: A routine data linkage study 2003-2018', Age and Ageing, vol. 51, no. 12, afac252. https://doi.org/10.1093/ageing/afac252

TY - JOUR

T1 - Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales

T2 - A routine data linkage study 2003-2018

AU - Ritchie, Leona A

AU - Harrison, Stephanie L

AU - Penson, Peter E

AU - Akbari, Ashley

AU - Torabi, Fatemeh

AU - Hollinghurst, Joe

AU - Harris, Daniel

AU - Oke, Oluwakayode B

AU - Akpan, Asangaedem

AU - Halcox, Julian P

AU - Rodgers, Sarah E

AU - Lip, Gregory Y H

AU - Lane, Deirdre A

PY - 2022/12

Y1 - 2022/12

N2 - Objective: To determine atrial fibrillation (AF) prevalence and temporal trends, and examine associations between AF and risk of adverse health outcomes in older care home residents. Methods: Retrospective 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. Results: There 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). Conclusions: Older 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.

AB - Objective: To determine atrial fibrillation (AF) prevalence and temporal trends, and examine associations between AF and risk of adverse health outcomes in older care home residents. Methods: Retrospective 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. Results: There 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). Conclusions: Older 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.

KW - Atrial fibrillation

KW - care homes

KW - health outcomes

KW - older people

KW - prevalence

KW - stroke

UR - http://www.scopus.com/inward/record.url?scp=85146888030&partnerID=8YFLogxK

U2 - 10.1093/ageing/afac252

DO - 10.1093/ageing/afac252

M3 - Article

C2 - 36469091

AN - SCOPUS:85146888030

SN - 0002-0729

VL - 51

JO - Age and Ageing

JF - Age and Ageing

IS - 12

M1 - afac252

ER -

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

Abstract

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