Abstract
Aims:Atrial fibrillation (AF) is a public health problem and its prevalence is increasing worldwide. Electronic cohorts, with large electrocardiogram (ECG) databases linked to mortality data, can be useful in determining prognostic value of ECG abnormalities. Our aim is to evaluate the risk of mortality in patients with AF from Brazil.Methods:This observational retrospective study of primary care patients was developed with the digital ECG database from the Telehealth Network of Minas Gerais, Brazil. ECGs performed from 2010 to 2017 were interpreted by cardiologists and the University of Glasgow automated analysis software. An electronic cohort was obtained linking data from ECG exams and those from a national mortality information system, using standard probabilistic linkage methods. We considered only the first ECG of each patient. Patients under 16 years were excluded. Hazard ratios (HR) for mortality were adjusted for demographic and self-reported clinical factors and estimated with Cox regression.Results:From a dataset of 1,773,689 patients, 1,558,421 were included, mean age 51.6 years; 40.2% male. There were 3.34% deaths from all causes in 3.68 years of median follow up. The prevalence of AF was 1.33%. AF was an independent risk factor for all-cause mortality (HR 2.10, 95%CI 2.03–2.17) and cardiovascular mortality (HR 2.06, 95%CI 1.86–2.29). Females with AF had a higher risk of overall and cardiovascular mortality compared with males (p < 0.001).Conclusions:AF was a strong predictor of cardiovascular and all-cause mortality in a primary care population, with increased risk in women.Condensed abstractTo assess risk of mortality in AF patients, an electronic cohort was obtained linking data from ECG exams of Brazilian primary care patients and a national mortality information system. From 1,558,421 patients, AF (prevalence 1.33%) carried a higher risk of overall and cardiovascular mortality, with increased risk in women.What’s NewThis is the first study with a large Brazilian electronic cohort to evaluate the risk of mortality linked to AF in primary care patients.AF patients from a Brazilian primary care population had a higher risk of death for all causes (HR 2.10, 95%CI 2.03–2.17) and cardiovascular mortality (HR 2.06, 95%CI 1.86–2.29).Female patients with AF had an increased risk of overall and cardiovascular mortality compared with male patients (p < 0.001).
Highlights
As the world population ages, the prevalence of atrial fibrillation (AF) is increasing, with a consequent increase in medical and economic global burden [1]
It can be considered representative of the country [13], as age distribution and percentage of urbanization are similar to the overall national pattern, as is the social inequality: the north and the northeast of Minas Gerais have a low Human Development Index (HDI) similar to the North and Northeast Brazil, while the west and south of the state have an HDI similar to the areas with the highest HDI of the country [14]
Hypertension was reported in 31.6% of patients, diabetes in 6.5%, dyslipidemia in 3.9%, Chagas disease in 2.2%, previous myocardial infarction in 0.7%, chronic obstructive pulmonary disease (COPD) in 0.7%, and 7.0% reported current smoking
Summary
As the world population ages, the prevalence of atrial fibrillation (AF) is increasing, with a consequent increase in medical and economic global burden [1]. Atrial fibrillation increases the risk of all-cause mortality, cardiovascular mortality and morbidity [5,6]. Half of the world population is concentrated in a few rapidly developing countries: Bangladesh, Brazil, China, India, Indonesia, Nigeria, and Pakistan [10]. In these countries, populations of individuals over 60 years are predicted to at least double by 2050 [10]. With rapidly ageing populations, the costs of AF are especially likely to balloon [10]
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