Improvement in age- and sex-dependent mortality in patients with atrial fibrillation between 2011 and 2016 – a nationwide retrospective study from Hungary
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2nd Department of Medicine and Nephrological Center, Faculty of Medicine, University of Pécs, Hungary
Bekes County Central Hospital Pandy Kalman Branch, Cardiology Department, Gyula, Hungary
Hetényi Géza Jász-Nagykun-Szolnok County Hospital, Cardiology Department, Szolnok, Hungary
Heart Centre Balatonfüred and Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
RxTarget Ltd., Szolnok, Hungary
University of Veterinary Medicine, Budapest, Hungary
Eötvös Loránd University, Budapest, Hungary
Department of Cardiology, Military Hospital, Budapest, Hungary
Petz Aladar County Teaching Hospital, Department of Cardiology, Hungary
Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Heart and Vascular Center, Semmelweis University, Budapest, Hungary
Submission date: 2020-09-07
Final revision date: 2020-10-12
Acceptance date: 2020-10-12
Online publication date: 2021-01-11
Corresponding author
Zoltan Kiss   

2nd Department of Medicine and Nephrological Center, Faculty of Medicine, University of Pécs, Pacsirta str 1, H-7624, Pécs, Hungary
Atrial fibrillation (AF) is associated with a higher risk of mortality; however, detailed analysis on the excess risk of death of patients diagnosed with AF compared to a non-AF population has not been carried out.

Material and methods:
In our nationwide study, all AF patients were included if the I48 ICD-code was recorded twice in the Hungarian National Health Insurance Fund (NHIF) database between 2009 and 2016. The annual mortality rates and rate ratios of AF patients compared with the non-AF population (excess risk) were evaluated as well as the change of these parameters between 2011 and 2016.

We identified 88,848 to 123,255 females and 80,525 to 116,448 males between 2011 and 2016 in the database. The excess risk of AF compared to the non-AF population was higher in females: the rate ratio (RR) was 4.47 (95% CI: 4.35–4.58; p < 0.001) versus 3.34 (95% CI: 3.27–3.40; p < 0.001) in 2011. We found significant reductions in the mortality rates of the AF population between 2011 and 2016 (18.0% p = 0.037 in females and 17.7% p < 0.001 in males) while reductions in excess mortality were significant in the older age groups (age 60 years and above). Though the age-specific mortality rates were higher among the older population and in males, mortality RR was higher in the lower age groups and in females.

By implementing a novel methodology, we were able to express the mortality risk of the total AF population. We found relevant reduction in the age-standardised mortality rates in both sexes during this 6-year period, which exceeded the reduction of mortality rates in the non-AF population.

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