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Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study)
Insights
Atrial fibrillation (AF) is common in older adults, often linked to cardiovascular issues. This study suggests "lone AF" may be rare in the elderly without underlying heart disease.
Area of Science:
- Cardiology
- Geriatrics
- Epidemiology
Background:
- Atrial fibrillation (AF) is a prevalent arrhythmia in the elderly, a significant risk factor for embolic stroke.
- Existing AF prevalence studies often rely on hospital-based, selected populations, limiting generalizability.
- The Cardiovascular Health Study (CHS) provides a population-based, longitudinal dataset for investigating AF risk factors in older adults.
Purpose of the Study:
- To determine the prevalence and correlates of atrial fibrillation in a large, population-based cohort of individuals aged 65 years and older.
- To examine the association between AF and clinical/subclinical cardiovascular disease.
- To evaluate the concept of "lone atrial fibrillation" in the elderly population.
Main Methods:
- Analysis of baseline data from the Cardiovascular Health Study, a longitudinal study of 5,201 men and women aged >= 65 years.
- Diagnosis of atrial fibrillation (AF) through standard clinical assessments.
- Statistical analysis to identify independent correlates of AF prevalence, including demographic, clinical, and echocardiographic factors.
Main Results:
- Overall AF prevalence was 4.8% in women and 6.2% in men, increasing with age, particularly in women.
- AF prevalence was significantly higher in those with clinical cardiovascular disease (9.1%) and subclinical disease (4.6%) compared to those without (1.6%).
- Independent correlates of AF included advanced age, congestive heart failure, valvular heart disease, stroke history, enlarged left atrium, abnormal valve function, and treated hypertension.
Conclusions:
- The low prevalence of AF in elderly individuals without clinical or subclinical cardiovascular disease challenges the concept and clinical utility of "lone atrial fibrillation."
- Cardiovascular disease is a strong determinant of AF prevalence in the elderly.
- Findings underscore the importance of comprehensive cardiovascular assessment in elderly patients diagnosed with AF.
Abstract:
Atrial fibrillation (AF) is a common arrhythmia in elderly persons and a common cause of embolic stroke. Most studies of the prevalence and correlates of AF have used selected, hospital-based populations. The Cardiovascular Health Study is a population-based, longitudinal study of risk factors for coronary artery disease and stroke in 5,201 men and women aged > or = 65 years. AF was diagnosed in 4.8% of women and in 6.2% of men at the baseline examination, and prevalence was strongly associated with advanced age in women. Prevalence of AF was 9.1% in men and women with clinical cardiovascular disease, 4.6% in patients with evidence of subclinical but no clinical cardiovascular disease, and only 1.6% in subjects with neither clinical nor subclinical cardiovascular disease. A history of congestive heart failure, valvular heart disease and stroke, echocardiographic evidence of enlarged left atrial dimension, abnormal mitral or aortic valve function, treated systemic hypertension, and advanced age were independently associated with the prevalence of AF. The low prevalence of AF in the absence of clinical and subclinical cardiovascular disease calls into question the existence and clinical usefulness of the concept of so-called "lone atrial fibrillation" in the elderly.