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The incidence of atrial fibrillation is high in patients over 65 initiating dialysis in the United States, and has been increasing over the last 13 years, according to a study published in Circulation. Mortality from AF has declined during the same time period, but remained >50% during the first year after newly diagnosed atrial fibrillation, the study concluded. The authors speculated that the trend towards better outcomes could be explained by higher rates of warfarin use, but data on it were not available.
Researchers from Stanford University School of Medicine and Duke Clinical Research Institute followed 258,605 dialysis patients older than 67, who had Medicare and initiated dialysis in between 1995 and 2007. None of the dialysis patients had been diagnosed with atrial fibrillation within the previous two years.
The researchers used multivariable proportional hazards regression to examine temporal trends and associations of race and ethnicity with incident atrial fibrillation. They also studied temporal trends in the mortality and risk of ischemic stroke after new atrial fibrillation. Within the follow up, 76,252 patients experienced atrial fibrillation. Incidence of atrial fibrillation increased 11% from 1995 to 2007.
African Americans (-30%), Asians (-19%), Native Americans (-42%), and Hispanics (-29%) all had lower rates of atrial fibrillation than non-Hispanic whites. Mortality after incident atrial fibrillation decreased by 22% from 1995 to 2008. Even more pronounced reductions were seen for incident ischemic stroke during these years.
The study is available, by subscription, on the Circulation website.