DOI QR코드

DOI QR Code

Incidence and Risk Factors for Atrial Fibrillation in Korea: the National Health Insurance Service Database (2002-2010)

  • Son, Mi Kyoung (Division of Cardiovascular and Rare Diseases, Center for Biomedical Science, Korea National Institute of Health) ;
  • Lim, Nam-Kyoo (Division of Cardiovascular and Rare Diseases, Center for Biomedical Science, Korea National Institute of Health) ;
  • Cho, Myeong-Chan (Department of Internal Medicine, College of Medicine, Chungbuk National University) ;
  • Park, Hyun-Young (Division of Cardiovascular and Rare Diseases, Center for Biomedical Science, Korea National Institute of Health)
  • Received : 2015.08.28
  • Accepted : 2015.12.08
  • Published : 2016.07.30

Abstract

Background and Objectives: Atrial fibrillation (AF) is a common arrhythmia that is known as an important independent risk factor for stroke. However, limited information is available on AF in Korea. This study evaluated the incidence of AF, its associated co-morbidities and risk factors for AF in Korea. Subjects and Methods: The National Health Insurance Service database between 2002 and 2010 was used in the study. Individuals<30 years old and those diagnosed with AF between 2002 and 2004 were excluded. Hazard ratios (HRs) according to co-morbidities and risk factors for AF were determined using a Cox proportional hazard model. Population attributable fractions (PAFs) of AF risk factors were determined. Results: During a 6-year follow-up period, 3517 (1.7%) developed AF. The incidence rates in men and women aged 30-39 years were 0.82 and 0.55 per 1000 person-years, respectively; the incidence rates further increased with age to 13.09 and 11.54 per 1000 person-years in men and women aged${\geq}80years$, respectively. The risk factors for incident AF were age, sex, body mass index (BMI), hypertension, ischemic heart disease (IHD) and heart failure. After adjusting for variables related to AF, the risk of AF was significantly associated with hypertension (HR 1.667), IHD (HR 1.639), heart failure (HR 1.521), and the PAFs for age, sex, BMI, hypertension, IHD, heart failure and diabetes mellitus were 30.6%, 10.1%, 3.4%, 16.6%, 8.2%, 5.3% and 0.8%, respectively. Conclusion: Incidence of AF increased with age and was higher in men than in women. A larger proportion of AF events was attributable to hypertension than to other co-morbidities.

Keywords

Acknowledgement

Supported by : Korea National Institute of Health intramural, NHIS

References

  1. Kannel WB, Abbott RD, Savage DD, McNamara PM. Coronary heart disease and atrial fibrillation: the Framingham Study. Am Heart J 1983;106:389-96. https://doi.org/10.1016/0002-8703(83)90208-9
  2. Wolf PA, Mitchell JB, Baker CS, Kannel WB, D'Agostino RB. Impact of atrial fibrillation on mortality, stroke, and medical costs. Arch Intern Med 1998;158:229-34. https://doi.org/10.1001/archinte.158.3.229
  3. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983-8. https://doi.org/10.1161/01.STR.22.8.983
  4. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001;285:2370-5. https://doi.org/10.1001/jama.285.18.2370
  5. Psaty BM, Manolio TA, Kuller LH, et al. Incidence of and risk factors for atrial fibrillation in older adults. Circulation 1997;96:2455-61. https://doi.org/10.1161/01.CIR.96.7.2455
  6. Aronow WS, Ahn C, Gutstein H. Prevalence and incidence of cardiovascular disease in 1160 older men and 2464 older women in a long-term health care facility. J Gerontol A BiolSci Med Sci 2002;57:M45-6. https://doi.org/10.1093/gerona/57.1.M45
  7. Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA 1994;271:840-4. https://doi.org/10.1001/jama.1994.03510350050036
  8. Heeringa J, van der Kuip DA, Hofman A, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006;27:949-53. https://doi.org/10.1093/eurheartj/ehi825
  9. Piccini JP, Hammill BG, Sinner MF, et al. Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993-2007. Circ Cardiovasc Qual Outcomes 2012;5:85-93. https://doi.org/10.1161/CIRCOUTCOMES.111.962688
  10. Lip GY, Brechin CM, Lane DA. The global burden of atrial fibrillation and stroke: a systematic review of the epidemiology of atrial fibrillation in regions outside North America and Europe. Chest 2012;142:1489-98. https://doi.org/10.1378/chest.11-2888
  11. Tse HF, Wang YJ, Ahmed Ai-Abdullah M, et al. Stroke prevention in atrial fibrillation--an Asian stroke perspective. Heart Rhythm 2013;10:1082-8. https://doi.org/10.1016/j.hrthm.2013.03.017
  12. Miyasaka Y, Barnes ME, Gersh BJ, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006;114:119-25. https://doi.org/10.1161/CIRCULATIONAHA.105.595140
  13. Krijthe BP, Kunst A, Benjamin EJ, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J 2013;34:2746-51. https://doi.org/10.1093/eurheartj/eht280
  14. Lee KS, Choi SJ, Park SH, Kim HL, Min H, Park HY. Prevalence of atrial fibrillation in middle-aged people in Korea: The Korean Genome and Epidemiology Study. Korean Circ J 2008;38:601-5. https://doi.org/10.4070/kcj.2008.38.11.601
  15. Jeong JH. Prevalence of and risk factors for atrial fibrillation in Korean adults older than 40 years. J Korean Med Sci 2005;20:26-30.
  16. Wang TJ, Parise H, Levy D, D'Agostino RB Sr, Wolf PA, Vasan RS, Benjamin EJ. Obesity and the risk of new-onset atrial fibrillation. JAMA 2004;292:2471-7. https://doi.org/10.1001/jama.292.20.2471
  17. Schnabel RB, Sullivan LM, Levy D, et al. Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. Lancet 2009;373:739-45. https://doi.org/10.1016/S0140-6736(09)60443-8
  18. Djoussé L, Levy D, Benjamin EJ, et al. Long-term alcohol consumption and the risk of atrial fibrillation in the Framingham Study. Am J Cardiol 2004;93:710-3. https://doi.org/10.1016/j.amjcard.2003.12.004
  19. Friberg J, Scharling H, Gadsboll N, Truelsen T, Jensen GB; Copenhagen City Heart Study. Comparison of the impact of atrial fibrillation on the risk of stroke and cardiovascular death in women versus men (The Copenhagen City Heart Study). Am J Cardiol 2004;94:889-94. https://doi.org/10.1016/j.amjcard.2004.06.023
  20. Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 1998;82:2N-9. https://doi.org/10.1016/S0002-9149(98)00583-9
  21. Lloyd-Jones DM, Wang TJ, Leip EP, et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 2004;110:1042-6. https://doi.org/10.1161/01.CIR.0000140263.20897.42
  22. Frost L, Hune LJ, Vestergaard P. Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Am J Med 2005;118:489-95. https://doi.org/10.1016/j.amjmed.2005.01.031
  23. Wang TJ, Parise J, Levy D, et al. Obesity and the risk of new-onset atrial fibrillation. JAMA 2004;292:2471-7. https://doi.org/10.1001/jama.292.20.2471
  24. Rodriguez CJ, Soliman EZ, Alonso A,et al. Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors: the Multi-Ethnic Study of Atherosclerosis. Ann Epidemiol 2015;25:71-6.e1. https://doi.org/10.1016/j.annepidem.2014.11.024
  25. Allessie MA, Boyden PA, Camm AJ, et al. Pathophysiology and prevention of atrial fibrillation. Circulation 2001;103:769-77. https://doi.org/10.1161/01.CIR.103.5.769
  26. Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials. Arch Intern Med 1994;154:1449-57. https://doi.org/10.1001/archinte.1994.00420130036007
  27. Suh HS, Kang HY, Kim J, Shin E. Effect of health insurance type on health care utilization in patients with hypertension: a national health insurance database study in Korea. BMC Health Serv Res 2014;14:570. https://doi.org/10.1186/s12913-014-0570-9

Cited by

  1. Risk of Ischemic Stroke in Patients With Non-Valvular Atrial Fibrillation Not Receiving Oral Anticoagulants ― Korean Nationwide Population-Based Study ― vol.81, pp.8, 2016, https://doi.org/10.1253/circj.cj-16-1267
  2. Hypertension and Atrial Fibrillation: An Intimate Association of Epidemiology, Pathophysiology, and Outcomes vol.30, pp.8, 2016, https://doi.org/10.1093/ajh/hpx013
  3. Proteinuria Detected by Urine Dipstick Test as a Risk Factor for Atrial Fibrillation: A Nationwide Population-Based Study vol.7, pp.None, 2016, https://doi.org/10.1038/s41598-017-06579-0
  4. Prevalence of Atrial Fibrillation in Korean Population vol.18, pp.4, 2016, https://doi.org/10.18501/arrhythmia.2017.030
  5. Estimated glomerular filtration ratio is a better index than creatinine clearance (Cockcroft-Gault) for predicting the prevalence of atrial fibrillation in the general Japanese population vol.41, pp.6, 2016, https://doi.org/10.1038/s41440-018-0032-6
  6. Trend of Prevalence of Atrial Fibrillation and use of Oral Anticoagulation Therapy in Patients With Atrial Fibrillation in South Korea (2002–2013) vol.28, pp.2, 2016, https://doi.org/10.2188/jea.je20160149
  7. Management of Common Arrhythmia in the Neurological Intensive Care Unit vol.11, pp.1, 2018, https://doi.org/10.18700/jnc.180050
  8. Atrial fibrillation in patients with first-ever stroke: Incidence trends and antithrombotic therapy before the event vol.13, pp.12, 2018, https://doi.org/10.1371/journal.pone.0209198
  9. The Association Between Diabetes Mellitus and Atrial Fibrillation: Clinical and Mechanistic Insights vol.10, pp.None, 2016, https://doi.org/10.3389/fphys.2019.00135
  10. Scrub Typhus and Abnormal Electrocardiography vol.100, pp.2, 2019, https://doi.org/10.4269/ajtmh.17-0565
  11. Effectiveness and safety of non-vitamin K antagonist oral anticoagulants in octogenarian patients with non-valvular atrial fibrillation vol.14, pp.3, 2019, https://doi.org/10.1371/journal.pone.0211766
  12. Increased risk of atrial fibrillation in patients with inflammatory bowel disease: A nationwide population-based study vol.25, pp.22, 2016, https://doi.org/10.3748/wjg.v25.i22.2788
  13. Five-year nationwide incidence of macular hole requiring surgery in Korea vol.103, pp.11, 2019, https://doi.org/10.1136/bjophthalmol-2018-313237
  14. Fluctuating renal function and the risk of incident atrial fibrillation: a nationwide population-based study vol.9, pp.1, 2019, https://doi.org/10.1038/s41598-019-54528-w
  15. Invited review: hypertension and atrial fibrillation: epidemiology, pathophysiology, and implications for management vol.33, pp.12, 2019, https://doi.org/10.1038/s41371-019-0279-7
  16. Cost-Effectiveness of Rate- and Rhythm-Control Drugs for Treating Atrial Fibrillation in Korea vol.60, pp.12, 2019, https://doi.org/10.3349/ymj.2019.60.12.1157
  17. Differences in Epidemiology and Risk Factors for Atrial Fibrillation Between Women and Men vol.7, pp.None, 2020, https://doi.org/10.3389/fcvm.2020.00003
  18. Population-Based Screening or Targeted Screening Based on Initial Clinical Risk Assessment for Atrial Fibrillation: A Report from the Huawei Heart Study vol.9, pp.5, 2016, https://doi.org/10.3390/jcm9051493
  19. Twelve-year incidence of retinal vein occlusion and its trend in Korea vol.258, pp.10, 2020, https://doi.org/10.1007/s00417-020-04811-8
  20. Medical Health Records-Based Mild Cognitive Impairment (MCI) Prediction for Effective Dementia Care vol.18, pp.17, 2016, https://doi.org/10.3390/ijerph18179223