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Abstract
Background Atrial fibrillation (AF) prevalence is rising due to population ageing and comorbidity is an increasing problem. The aim of this study was to examine the prevalence and association of coexisting health conditions among adults with AF in the general population.
Methods Cross-sectional analysis of Clinical Practice Research Datalink (CPRD) primary care electronic medical records in England linked to hospital admissions as of 30 November 2015. CPRD is broadly representative of the UK general population in terms of age, sex and ethnicity. We estimated prevalence and used logistic regression examining risk factors of age, sex and socioeconomic status (SES) to compare prevalence of 252 physical and mental health conditions and 23 higher level health condition groups in adults with AF compared with adults without AF.
Results 34 338 adults with AF (57% male; 83% ≥65 years) and 907 739 without AF (49% male; 23% ≥65 years) were identified. Adjusted for age and sex, adults with AF were significantly more likely to have 20/23 (87%) health condition groups than adults without AF. The most prevalent health condition groups in adults with AF were cardiovascular (prevalence of 89% in adults with AF vs 26% in adults without AF, adjusted OR (aOR) 5.82, 95% CI 5.60 to 6.05), gastrointestinal (62% vs 37%, aOR 1.34, 95% CI 1.31 to 1.38) and orthopaedic (58% vs 24%, aOR 1.32, 95% CI 1.29 to 1.35). 151/252 individual conditions were significantly more common in adults with AF including cardiovascular conditions such as cardiomyopathy (4.5% vs 0.3%, aOR 9.58, 95% CI 8.88 to 10.35) and heart failure (18% vs 0.7%, aOR 9.07, 95% CI 8.70 to 9.46), and non-cardiovascular conditions such as pleural effusion (16% vs 1.8%, aOR 3.55, 95% CI 3.42 to 3.67) and oesophageal malignancy (0.3% vs 0.0%, aOR 2.14, 95% CI 1.69 to 2.70). Associations were similar after SES adjustment.
Conclusions While cardiovascular conditions are highly prevalent and strongly associated with AF, a wide spectrum of non-cardiovascular conditions were also strongly associated, requiring a greater understanding of managing comorbid conditions with management principles contradictory to AF.
- Atrial Fibrillation
- Epidemiology
- Electronic Health Records
- Cardiovascular Diseases
Data availability statement
Data may be obtained from a third party and are not publicly available. Deidentified patient data used in this study are not publicly available and may be obtained from the Clinical Practice Research Datalink according to their standard terms and conditions (https://www.cprd.com/).
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Data availability statement
Data may be obtained from a third party and are not publicly available. Deidentified patient data used in this study are not publicly available and may be obtained from the Clinical Practice Research Datalink according to their standard terms and conditions (https://www.cprd.com/).
Footnotes
Contributors TJD: study design; data preparation, analysis, visualisation and interpretation; writing, review and editing. BG: study design; data preparation and interpretation; writing, review and editing. DM-M: data curation; study design; data preparation, analysis and visualisation; review and editing. DM: study concept and design; funding application; data collection; data preparation, analysis and interpretation; writing, review and editing. TJD, DM-M and DM accessed and verified the data. All authors were responsible for the decision to submit the manuscript. DM is the guarantor for this study. ChatGPT was used to generate code for the statistical processing language R which was considered for some aspects of data analysis including creating condition groups and formatting figures.
Funding Core data management was funded by the Chief Scientist Office (HIPS-18-30). TJD was funded by an NHS Education for Scotland, Academic Fellowship in General Practice. DM was funded by a Wellcome Trust Clinical Research Career Development Fellowship during the course of this work. DM and DM-M previously received funding from the HDR-UK Precision-Therapeutics programme.
Disclaimer No funders had any role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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