Ritchie, LA, Harrison, SL, Penson, PE, Akbari, A, Torabi, F, Hollinghurst, J, Harris, D, Oke, OB, Akpan, A, Halcox, JP, Rodgers, SE, Lip, GYH and 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, 51 (12). ISSN 0002-0729

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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.

Item Type:	Article
Additional Information:	Processed by mike for ms to check
Uncontrolled Keywords:	Atrial fibrillation; care homes; health outcomes; older people; prevalence; stroke; 1103 Clinical Sciences; 1117 Public Health and Health Services; 1701 Psychology; Geriatrics
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RS Pharmacy and materia medica
Divisions:	Pharmacy & Biomolecular Sciences
Publisher:	Oxford University Press
SWORD Depositor:	A Symplectic
Date Deposited:	08 Dec 2022 11:51
Last Modified:	12 Dec 2022 08:53
DOI or ID number:	10.1093/ageing/afac252
URI:	https://researchonline.ljmu.ac.uk/id/eprint/18350

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