Factors that influence awareness and treatment of atrial fibrillation in older adults

• Published in: QJM : An International Journal of Medicine 2013-05, Vol.106 (5), p.415-424
• Main Authors: Frewen, J, Finucane, C, Cronin, H, Rice, C, Kearney, P M, Harbison, J, Kenny, R A
• Format: Article
• Language: English
• Subjects: Age Distribution; Aged; Aged, 80 and over; Anticoagulants - therapeutic use; Atrial Fibrillation - diagnosis; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Drug Utilization - statistics & numerical data; Educational Status; Electrocardiography; Female; Health Knowledge, Attitudes, Practice; Humans; Ireland - epidemiology; Longitudinal Studies; Male; Middle Aged; Platelet Aggregation Inhibitors - therapeutic use; Prevalence; Sex Distribution; Stroke - etiology; Stroke - prevention & control
• ISSN: 1460-2725; 1460-2393
• DOI: 10.1093/qjmed/hct060

The aims of this study were to investigate the prevalence of atrial fibrillation (AF), treatment rates of AF and the factors underlying awareness and treatment, in a large nationally representative study. A population sample of people aged 50+, living in the Republic of Ireland, were recruited as part of The Irish longitudinal study on ageing. Ten-minute electrocardiogram recordings were obtained (n = 4890), and analysed to detect AF. Self-reported arrhythmias, subjective and objective health measures (cardiovascular diseases, CHA2DS2-VASc variables and blood pressure) and medications were also recorded. Logistic regressions were used to determine associations with outcomes of presence of AF, lack of awareness and untreated AF. Overall prevalence of AF was 3% (95% CI: 2.4-3.7%), with a marked age gradient and sex difference [4.8% (men) vs. 1.4% (women); P < 0.0001]. In total, 67.8% were at high risk of stroke (CHA2DS2-VASc ≥ 2), of whom 59.3% were inadequately treated. A high proportion of 38.1% were unaware of having AF. CHA2DS2-VASc nor HAS-BLED score influenced awareness or treatment. Lack of awareness was associated with lower education (P = 0.01), lower cognition (P = 0.04), rural location (OR = 3.67; P = 0.02) and number of general practitioner visits (P = 0.01), whereas untreated AF was influenced by frailty status (P = 0.04). With projected doubling of numbers of persons over 80 in the next 30 years in the British Isles, detection and management of AF is pressing. Two-thirds of adults at high risk of stroke were inadequately treated. More regular screening for AF, application of criteria for stroke and bleeding risk and awareness of factors influencing diagnosis and treatment is recommended.