Abstract 13526: Global and National Atrial Fibrillation Quality of Care, From 1990 to 2017: Results From the GBD Study

Abstract

Introduction: Afib has a drastically higher incidence and burden among elderly. Aside from cardio and cerebrovascular outcomes in these patients, Afib individually brings about a significant mortality among elderly. Scoring systems like CHA2DS2-VASc imply that female gender, advanced age, and comorbidities augment the morbidity of Afib. Hypothesis: This study aims to evaluate the global and national discrepancies in Afib quality of care (QoC) within a 38-year time among over 70-year-old population. Methods: Four key epidemiologic indices were measured using the data from the estimates of ‘Global Burden of Diseases’ study, 2017: Mortality to incidence, DALY to prevalence, YLL to YLD, and Prevalence to Incidence ratio. Principal Component Analysis was utilized to find the highest value of all eigenvectors of the 4 estimates. The adaptive component derived from this analysis was set as the QoC index (QCI), a centile-based score reflecting better QoC with inclining values. Statistical analyses were done by R software v3.6.1. Results: QCI score decreased globally in over 70-year-old population of both females (-4.61%), and males (-3.92%). The gender disparity increased in favor of higher scores for males (-0.50 in 1990, -1.19 in 2017). At the country level, majority of nations had decreased QCI within this period (Figure 1). The US had the second highest QCI in over 70-year-old population (98.30), as well as 80-84 (98.24) and 85-89 years (98.07), specifically. Although the QCI dropped 2.18 scores from 1990 to 2017, the female-male disparity decreased in age group of over 70 (4.15 to 3.44) in US. Conclusions: Predominant world-wide decline in QCI, could imply the decreased quality of care for patients with Afib. Observed gender-specific discrepancy in a disease with female-dominant morbidity calls for the necessity to adapt health policies accordingly. However, further studies with adjustment for concomitant risk factors are required to address the underlying causes.