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2. Epidemiology

2.1 Incidence and prevalence

AF is the most common sustained arrhythmia encountered in clinical practice.[29] Current evidence suggests that the prevalence of AF is 1%-2% in the general population, and increases significantly with age (< 1.0% up to 50 years of age, to 4% at 65 years, and 12% of those 80 years of age or older).[29],[30] Although the incidence has been relatively stable over time (approximately 28 per 1000 person-years), the overall prevalence of AF is increasing because of changing population demographics (eg, from 41 cases per 1000 in 1993 to 85 cases per 1000 in 2007).[29],[31] However, the true prevalence of AF is likely to be substantially higher than 1-2%, as these historical estimates were derived from populations with AF diagnosed using ECG, and did not routinely account for patients with paroxysmal AF (which is estimated to be approximately two-thirds of the AF population) or patients with silent AF.[32][35] When factoring in patients with paroxysmal and silent AF, the prevalence of AF increases from 500,000 to nearly 1 million Canadians.[36],[37]

2.2 Morbidity and mortality

Although rarely acutely life-threatening, AF is associated with significant impairments in functional capacity and health-related quality of life (HRQOL), as well as with an increased morbidity and mortality. These impairments have been noted across multiple HRQOL domains, with a magnitude comparable or worse than that observed in patients with HF or who are on long-term hemodialysis.[38][42] Even in the absence of perceived symptoms, AF patients objectively experience reduced global life satisfaction.[38] AF is independently associated with a 1.5- to 4-fold increased risk of mortality, which is predominantly due to increased risk of thromboembolic events and ventricular dysfunction.[31],[40],[43][46] Nonanticoagulated patients with AF have a 3- to 5-fold increased risk of stroke, which are generally more severe (greater resource utilization, long-term disability, and mortality) and more recurrent than strokes unrelated to AF.[43],[47][50] To date, the only therapeutic intervention that has been consistently and definitively shown to improve survival in the AF population is the use of oral anticoagulation (OAC; see section 8).[51],[52] Strategies targeting modifiable cardiovascular risk factors and relevant comorbid conditions offer potential opportunities to further improve survival (see sections 3 and 6).

2.3 Health care resource utilization

The economic burden of AF care is substantial. A significant proportion of AF health care expenses are attributed to the direct costs associated with hospitalization and the provision of acute care.[29],[53][59] In Canada, AF resulted in 8815 same-day procedures, 76,964 ED visits, and 64,214 acute care admissions (25,892 with AF as the principal diagnosis and 38,222 with AF as a comorbid diagnosis) in the 2007-2008 fiscal year. The annual direct cost of AF care adjusted to 2020 Canadian dollars (CAD$) was $956 million: $66 million for ED visits with AF as the principal diagnosis and $20 million with comorbid AF; $204 million for hospitalization with AF as the principal diagnosis and $634 million with comorbid AF; and $32 million for AF-related day procedures.[58] On a per-patient basis, the excess annual direct cost of AF has been estimated to be $16,944-$19,529 (adjusted 2020 US dollars).[55],[56] In addition to these direct costs, the annual indirect costs (eg, days of work missed because of illness) have been estimated to be $3082 higher for AF patients compared with those without AF.[57] It is important to recognize that the cost of care is not uniform across the spectrum of AF. Specifically, the annual inpatient and outpatient direct costs are more than twice as high for patients with “primary AF” compared with patients with “secondary AF” (see section 1.2).[57]


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