Estimation of the incidence of atrial fibrillation treated by oral anticoagulants in France from 2010 to 2016

Abstract

Few epidemiological data on Atrial Fibrillation (AF) incidence are available in France. The “Système national des données de santé” (SNDS), which exhaustively records reimbursed healthcare data, could be useful to estimate the incidence of treated AF by oral anticoagulant (OAC). However, OAC are not indicated for AF only and the indication of pharmacological treatment is not available in the SNDS. The objective of this study was to estimate the incidence of AF treated by OAC in France from 2010 to 2016. For each year between 2010 and 2016, we identified patients initiating OAC in the SNDS. OAC indication for AF, deep venous thrombosis (DVT) or pulmonary embolism (PE), orthopedic procedure or valvulophathy was determined by hospitalization diagnoses, specific procedures or long-term disease registration. Patients with none of these criteria were considered unclassified. Among patients with identified diagnosis of AF or DVT/PE, demographics and healthcare data prior to OAC initiation were included in a logistic regression model discriminating AF vs DVT/PE indications. This model was applied to unclassified patients in order to estimate their probability to have AF. The model had good predicting properties (area under the ROC curve of 0.92). In 2016, 123,427 patients had a diagnosis of AF prior to OAC initiation and 138,811 were unclassified patients initiating OAC. Among these, 34%, 29%, 25% and 12% had respectively a probability of ≥ 0.9, [0.5–0.9[, [0.1–0.5[and < 0.1 to have AF. The cumulative incidence rates were 185/100,000 for identified AF and 253, 311, 363 and 386/100,000 inhabitants after adding unclassified patients according to their AF probability. Important variations were observed over time, with incidence of treated AF patients 5 times higher in 2016 vs 2010. Incidence of AF treated by OAC was estimated between 185 and 386 per 100,000 in 2016 and was multiplied by more than 5 since 2010.