Declining Cardiovascular Mortality in Atrial Fibrillation Patients
A downward trend in cardiovascular mortality has prevailed for some time now, and we might take the data here as an example of ways in which improved options for detection and treatment produce results in specific portions of the patient population. Also worthy of note is the point that these older patients have many issues, and while slowing the pace of cardiovascular decline with age should have beneficial effects throughout the body, reduced cardiovascular mortality due to improved treatment that specifically focuses on cardiovascular disease allows other age-related conditions to claim a greater proportion of the population.
The research examined data from electronic health records of 72,412 patients from a representative sample of the UK population, who had been diagnosed with atrial fibrillation (AF) between 2001 and 2017. 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. The average patient was aged 75.6. Some 48.2% of patients were women, and 61.8% had three or more comorbidities. Over the study period, coexisting health concerns became more common, with almost 70% of newly diagnosed AF patients also having at least three comorbidities. Mortality rates at one year post diagnosis were investigated, as well as the number of hospital admissions with an overnight stay within 1 year of diagnosis.
Over the study period, 20% of patients died from any cause within a year of being diagnosed with AF - but this declined over time. However the researchers found that deaths due to cardiovascular and cerebrovascular events (strokes) more than halved over the study period. Cardiovascular deaths declined from 7.3% in 2001/02 to 3% in 2016/2017, while cerebrovascular 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.