Trends in hospital activity, morbidity and case fatality related to atrialfibrillation in Scotland, 1986-1996

Aims Atrial fibrillation is a common and important cause of cardiovascular morbidity and mortality that may become more prevalent due to an ageing pop ulation and more prolonged exposure to predisposing cardiovascular disease states. This study examines recent trends in hospitalizations related to at rial fibrillation in Scotland. Methods and Results Scotland (population 5.1 million) has a well described system for recording hospitalization data. All hospital discharges (and dea th) can be linked for each individual patient. We examined the period 1986- 1996, during which time a total of 103 085 hospitalizations with a principa l or secondary diagnosis of atrial fibrillation were recorded. The number o f hospitalizations with a principal diagnosis of atrial fibrillation increa sed threefold from 1869 in 1986 to 5757 in 1996; the number with a secondar y diagnosis rose from 3577 to 11 522. Similar increases were seen in the nu mber of patients hospitalized. in those having a 'first-ever' hospitalizati on and in population hospitalization rates overall. The average age of pati ents reset in men from 63.8 (SD 13.2) to 65.0 (13.2) years and in women fro m 72.2 (12.2) to 73.2 (11.4) years. The proportion of those aged >75 years rose from 33% to 35% in men and from 56% to 60% in women. Average length of stay and case fatality fell during this period, but, because of the overal l increase in hospitalizations. atrial fibrillation contributed to a growin g proportion of cardiovascular-related bed-days utilized (from 18% to 37% w ith atrial fibrillation coded in any diagnostic position). Conclusion The number of hospitalizations for atrial fibrillation has incre ased dramatically (two- to threefold) in recent years. These findings may b e due to a real increase in atrial fibrillation prevalence, changing medica l practice (e.g. coding or admission thresholds) or both. Consequently, the public health burden of atrial fibrillation is enormous. Moreover, the obs erved increase in atrial fibrillation-related hospital activity shows no si gn of abating.