A new decline in hospitalization with atrial fibrillation among the elderly

Recent studies of atrial fibrillation within the United States showed an increase in the number and rate of hospitalization and death from 1979 to 1999. We tested the hypothesis that the trends in hospitalization and death with atrial fibrillation would be upward and similar from 1999 to 2009.

We examined data for 1999-2009 from the US National Hospital Discharge Survey for diagnoses of atrial fibrillation (International Classification of Diseases, 9th Revision, Clinical Modification code 427.3) among up to 7 coded diagnoses and data from the National Vital Statistics System for deaths with atrial fibrillation (International Classification of Diseases 10th revision code I45). We computed all-listed diagnosis numbers and rates per 100,000 for discharges and deaths.

In 2009, the estimated number of all-listed diagnoses of atrial fibrillation in the United States was 2,643,000: 1,330,000 (50%) in women, 2,155,000 (82%) at ages 65+ years, and 467,000 (18%) first-listed diagnoses. At age 65+ years, the number increased from 2,049,000 in 1999 to 2,573,000 in 2005, and then decreased to 2,155,000 in 2009 (10% higher than 1999). The rate per 100,000 increased 17% from 5984 in 1999 to 6994 in 2005, and then decreased 22% to 5445 in 2009, 9% lower than 1999. The average annual percentage change was 3.12% from 1999 to 2005 compared with -5.00% from 2005 to 2009. Rates of death with atrial fibrillation increased 2% annually throughout the period.

In contrast to steadily increasing rates of death with atrial fibrillation, rates of diagnoses of atrial fibrillation at hospital discharge increased from 1999 to 2005, and then decreased slightly between 2005 and 2009. Further research is needed to assess explanations for these trends.