Epidemiology and Impact of A Little Bit of Afib" Margot E. Vloka, MD, FACC, FHRS St. Alphonsus Regional Medical Center Heart Institute Boise, Idaho

Transcription

1 Epidemiology and Impact of A Little Bit of Afib" Margot E. Vloka, MD, FACC, FHRS St. Alphonsus Regional Medical Center Heart Institute Boise, Idaho

2 Disclosures: Medtronic Biotronic AtriCure

3 What is Atrial Fibrillation? Atrial Fibrillation is an Atrial Cardiomyopathy 1 diagnosed by ECG and characterized by an irregulary irregular rhythm. 1 Any complex of structural, architectural, contractile or electrophysiological changes affecting the atria with the potential to produce clinically - relevant manifestations 1 Goette et al. Heart Rhythm, Vol 14, No 1, January 2017

4 Atrial Fibrillation is an: Age Dependant, Multifactorial, Chronic, Progressive, Inflammatory, Systemic, Heritable and Heterogeneous, Dangerous Disease Leading to a: Shorter, Less Satisfactory and Frequently Disabling Life

5 Wolf. Arch Intern Med. 1998;158:229-34, Hubbard, M. Am J Med Qual. 2014;29: Soliman, JAMA 2014;174:107-14, Singh-Manoux, Eur Heart J ; 2017;doi: /eurheartj/ehx208. Patients With Atrial Fibrillation High incidence of complications Stroke rate x 5 Heart failure x 3 Extracranial systemic embolic event x 2 MyocardiaI infarction x 2 Higher mortality rate x 2 Increased cognitive impairment or dementia in stroke-free individuals especially younger than 65 Greater health care costs than patients with other forms of cardiovascular diseases

6 Prevalence of Atrial Fibrillation Stratified by Gender and Age Naccarelli et al., Am J Cardiol 2009;104:

7 Incidence of Atrial Fibrillation Incidence of atrial fibrillation, Framingham Heart Study 38-year follow-up. Darker bars indicate men; and lighter bars, women. Adapted from: Benjamin et al. JAMA. 1994;271:

8 Projected Atrial Fibrillation Prevalence in the United States 12.1 mln 5.1 mln 7.0 mln 6.5 mln 9.3 mln Adapted from: Colilla et al. Am J Cardiol 2013; 112:

9 Projected Atrial Fibrillation Incidence in the United States 2.6 mln 500/100, mln Adapted from: Colilla et al. Am J Cardiol 2013; 112:

10 Trends in Cancer Incidence Rates in the United States Source: J Natl Cancer Inst 2017;109 (9):1-22. Age adjusted to the 2000 US standard population.

11 Estimated Incidence of Cancer and Atrial Fibrillation in the United States in 2017 Every 40 seconds someone has a heart attack or stroke Every 20 seconds someone in the United States is diagnosed with Atrial Fibrillation or malignant cancer for the first time Estimated new cases for 2017 Cancer 1 Atrial Fibrillation 2 Total 1.67 mln 1.64 mln Breast 255,000 Lung and bronchus 222,000 Prostate 161,000 Colon and rectum 135,000 1 American Cancer Society, Cancer.org accessed on , 2 Colilla et al. Am J Cardiol 2013; 112:

12 1 Adapted from: Lloyd-Jones et al. Circulation 2004;110:1042-6, 2 American Cancer Society, Cancer.org accessed on , 3 Naccarelli et al., Am J Cardiol 2009;104: Remaining Lifetime Risk of Developing AF 1, Cancer 2 or CVD 3 at Age of 40 Site Male Female 1 in 1 in CHD 2 3 Atrial Fibrillation 4 4 CHF 5 5 Stroke 6 5 Prostate 7 Breast 8 Lung & Bronchus Colon & Rectum 21 23

13 Adapted from: Picini et al. Eur Heart J 2014;35: , Mozaffarian et al. Circulation. 2015;131:e29-e322 Cumulative Incidence of Events After Diagnosis of Atrial Fibrillation In Medicare Patients 48.8%-AF 19.5%

14 Adapted from: Picini et al. Eur Heart J 2014;35: , Mozaffarian et al. Circulation. 2015;131:e29-e322 Cumulative Incidence of Events After Diagnosis of Atrial Fibrillation In Medicare Patients 48.8%-AF 54.9% -AF + MI 65.7% -AF + Stroke 73.1%-AF + CHF 19.5%

15 Long-Term Cardiovascular Event Risks Associated With Atrial Fibrillation 8354 women, 7052 men, Age y.o. followed for 20 years (27%) (45%) (66%) (89%) Cardiovascular event =hospitalizations (Myocardial Infarction, Stroke, Heart Failure) or deaths during 20-year follow-up, by the presence of Atrial fibrillation. Women five-fold increase of cardiovascular event. Men two-fold. Adapted from: Stewart et al. Am J Med. 2002;113:

16 Long-Term Cardiovascular Event Risks Associated With Atrial Fibrillation (71% women alive) (56% men alive) (72% men died) (86% women died) Age-adjusted, sex-specific cardiovascular event (hospitalizations or deaths) during 20-year follow-up, by the presence (n 100) or absence (n 15,306) of atrial fibrillation at baseline. CV Hospitalizatiom (Acute Miyocardial Infarction, Stroke,Heart Failure Adapted from: Stewart et al. Am J Med. 2002;113:

17 5-Year Survival By Primary (Invasive) Cancer Site In the United States PANCREAS 2. MESOTHELIOMA 3. BRAIN & CNS 4. LIVER & IBD 5. LUNG & BRONCHUS 6. ESOPHAGUS 7. STOMACH 8. OVARY 9. MYELOMA 10. CERVIX UTERI ATRIAL FIBRILLATION 11. HODGKIN LYMPHOMA 12. ORAL CAVITY & PHARYNX 13. RECTUM 14. NON-HODGKIN LYMPHOMA 15. COLON 16. KIDNEY&RENAL PELVIS 17. CHRONIC LYMPHOCYTIC LEUKEMIA 18. URINARY BLADDER 19. CORPUS UTERI 20. KAPOSI SARCOMA 21. MELANOMA 22. TESTIS 23. BREAST 24. THYROID 25. PROSTATE ATRIAL FIBRILLATION OVERALL Adapted from: Piccini, Eur Heart J 2014; 35, Howlader N Cancer Statistics Review, , NCI. Bethesda, MD,

18 The Most Common Comorbid Chronic Conditions Among Medicare Beneficiaries Beneficiaries 65 y.o. With AF* (N= ) With HF* (N= ) With Stroke* (N= ) With IHD* (N= ) % % % % Hypertension IHD Index Heart Failure 50.9 Index Diabetes Mellitus CKD COPD # 21.0 AF Index 28.8 # 18.7 Stroke # # Index # AF-Atrial Fibrillation, IHD-Ischemic Heart Disease, CKD-Chronic Kidney Disease, COPD-Chronic Obstructive Pulmonary Disease, *Data shown as a percentage of persons with index condition who also had a comorbidity, #-Not in top 10 comorbidities Modified from: Arnett et al, Circulation 2014;130: , CMS, Chronic Conditions Among Medicare Beneficiaries Chartbook, 2012 Edition. Baltimore, MD. 2012,. Hubbard, M. Am J Med Qual. 2014;29:

19 Causes of Death in Patient with Atrial Fibrillation Cardiac 46.00% sudden cardiac death 28.00% heart failure 15.00% myocardial infarction 3.00% Non-Vascular 29.79% cancer 11.00% infections 9.00% Ischemic Stroke/SE 5.74% Bleeding 5.64% Adapted from: Gomez-Outes et al. J Am Coll Cardiol 2016;68(23):

20 Conclusions: Atrial Fibrillation is an Atrial Cardiomyopathy We are in the middle of a global Atrial Fibrillation Epidemic There is a need to identify interventions beyond effective anticoagulation to further reduce mortality and morbidity in atrial fibrillation patients.

21 Co-morbidity among Chronic Conditions for Medicare FFS Beneficiaries: 2010 Centers for Medicare and Medicaid Services. Chronic Conditions among Medicare Beneficiaries, Chartbook, 2012 Edition. Baltimore, MD. 2012

22 Spending on Medicare Services as a Percentage of Total Medicare Spending Among Medicare FFS Beneficiaries by Number of Chronic Conditions: 2010 Centers for Medicare and Medicaid Services. Chronic Conditions among Medicare Beneficiaries, Chartbook, 2012 Edition. Baltimore, MD. 2012

23 Four Stages of Left Atrial (LA) Structural Remodeling (SRM) Based on 3-dimensional Late Gadolinium Enhancement MRI Christopher McGann et al. Circ Arrhythm Electrophysiol. 2014;7:23-30 Copyright American Heart Association, Inc. All rights reserved. 23

24 Atrial Fibrillation Management Center Neurology EP PCP Cardiology AF AF Patient Patient Pulmonary Cardiothoracic Surgery Endocrinology ER