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Estimated prevalence of undiagnosed atrial fibrillation in the United States

Author

Listed:
  • Mintu P Turakhia
  • Jason Shafrin
  • Katalin Bognar
  • Jeffrey Trocio
  • Younos Abdulsattar
  • Daniel Wiederkehr
  • Dana P Goldman

Abstract

Introduction: As atrial fibrillation (AF) is often asymptomatic, it may remain undiagnosed until or even after development of complications, such as stroke. Consequently the observed prevalence of AF may underestimate total disease burden. Methods: To estimate the prevalence of undiagnosed AF in the United States, we performed a retrospective cohort modeling study in working age (18–64) and elderly (≥65) people using commercial and Medicare administrative claims databases. We identified patients in years 2004–2010 with incident AF following an ischemic stroke. Using a back-calculation methodology, we estimated the prevalence of undiagnosed AF as the ratio of the number of post-stroke AF patients and the CHADS2-specific stroke probability for each patient, adjusting for age and gender composition based on United States census data. Results: The estimated prevalence of AF (diagnosed and undiagnosed) was 3,873,900 (95%CI: 3,675,200–4,702,600) elderly and 1,457,100 (95%CI: 1,218,500–1,695,800) working age adults, representing 10.0% and 0.92% of the respective populations. Of these, 698,900 were undiagnosed: 535,400 (95%CI: 331,900–804,400) elderly and 163,500 (95%CI: 17,700–400,000) working age adults, representing 1.3% and 0.09% of the respective populations. Among all undiagnosed cases, 77% had a CHADS2 score ≥1, and 56% had CHADS2 score ≥2. Conclusions: Using a back-calculation approach, we estimate that the total AF prevalence in 2009 was 5.3 million of which 0.7 million (13.1% of AF cases) were undiagnosed. Over half of the modeled population with undiagnosed AF was at moderate to high risk of stroke.

Suggested Citation

  • Mintu P Turakhia & Jason Shafrin & Katalin Bognar & Jeffrey Trocio & Younos Abdulsattar & Daniel Wiederkehr & Dana P Goldman, 2018. "Estimated prevalence of undiagnosed atrial fibrillation in the United States," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-11, April.
  • Handle: RePEc:plo:pone00:0195088
    DOI: 10.1371/journal.pone.0195088
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    References listed on IDEAS

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    1. Mark Weber-Krüger & Klaus Gröschel & Meinhard Mende & Joachim Seegers & Rosine Lahno & Beatrice Haase & Cord-Friedrich Niehaus & Frank Edelmann & Gerd Hasenfuß & Rolf Wachter & Raoul Stahrenberg, 2013. "Excessive Supraventricular Ectopic Activity Is Indicative of Paroxysmal Atrial Fibrillation in Patients with Cerebral Ischemia," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-7, June.
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    Cited by:

    1. Ali Bahrami Rad & Conner Galloway & Daniel Treiman & Joel Xue & Qiao Li & Reza Sameni & Dave Albert & Gari D Clifford, 2021. "Atrial fibrillation detection in outpatient electrocardiogram monitoring: An algorithmic crowdsourcing approach," PLOS ONE, Public Library of Science, vol. 16(11), pages 1-15, November.

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