A study of the contemporary atrial fibrillation epidemiology and oral anticoagulation in British Columbia : a population based study
department or school: Medicine, Faculty of
department or school: Population and Public Health (SPPH), School of
data provider: DSpace
degree campus: UBCV
creator: Daniele, Patrick
issued: 2020-03-26T15:30:34Z
issued: 2020
related degree: Master of Science - MSc
degree grantor: University of British Columbia
description: Background: Atrial fibrillation (AF) is the most common sustained arrhythmia with an estimated prevalence between 1-3%. There is a paucity of research studying the contemporary AF epidemiology and novel stroke prophylaxis pharmaceuticals for AF in Western Canada. Starting in 2011, the first direct oral anticoagulant (DOAC) drugs were approved in Canada. This thesis identifies and describes British Columbia’s (BC) AF population then explores epidemiological trends and differences in AF including incidence, prevalence, treatment preferences, and outcomes. Furthermore, age and sex differences are investigated in each endpoint to identify potential health inequalities. Methods: This study linked administrative healthcare databases to identify the AF population in BC from 2008 to 2016. Patient characteristics were defined at date of AF diagnosis. Clinical endpoints following AF diagnosis included hospital admission, use and type of oral anticoagulants (OAC), and adverse outcomes. Analyses were stratified by age and sex. Results: The incidence of AF remains stable throughout the study window at approximately 0.43% per year (431/100,000 in 2016). The prevalence of AF grew from 2.2% in 2008 to 3.2% in 2016 with provincial demographics shifting towards an older population. The rate of OAC use following incident AF diagnosis was sub-optimal; among patients guideline indicated for OAC, 45.9% received OAC within 100 days of diagnosis. Temporal trends were observed in first OAC; DOACs grew to approximately 65% of all initial OAC prescriptions by 2016. Apixaban and rivaroxaban were associated with lower risk of composite events (mortality, stroke, and heart failure) than warfarin (adjusted hazard ratios 0.75 (0.66, 0.86) and 0.77 (0.70, 0.86), respectively). By 2016, the sex difference in OAC use had disappeared and outcomes were comparable. Rates of incidence, prevalence, OAC use, and outcomes are strongly associated with age. Conclusions: The burden of AF is growing in BC; the …
aggregated CHO: https://circle.library.ubc.ca/rest/handle/2429/73809
note: A STUDY OF THE CONTEMPORARY ATRIAL FIBRILLATION EPIDEMIOLOGY AND ORAL ANTICOAGULATION IN BRITISH COLUMBIA: A POPULATION BASED STUDY by Patrick Daniele B.Sc., Simon Fraser University, 2015 A THESIS SUBMITTED IN PARTIAL FULFULLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE in The Faculty of Graduate and Postdoctoral Studies (Population and Public Health) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) March 2020 © Patrick Daniele, 2020 ii The following individuals certify that they have read, and recommend to the Faculty of Graduate and Postdoctoral Studies for acceptance, a thesis entitled: A Study of the Contemporary Atrial Fibrillation Epidemiology and Oral Anticoagulation in British Columbia: A Population Based Study submitted by Patrick Daniele in partial fulfillment of the requirements for the degree of Master of Science in Population and Public Health Examining Committee: Dr. Joel Singer, Professor, School of Population and Public Health, UBC Supervisor Dr. Karin Humphries, Associate Professor, Department of Medicine, UBC Supervisory Committee Member Dr. Jason Sutherland, Professor, School of Population and Public Health, UBC Additional Examiner Additional Supervisory Committee Members: Dr. Nathaniel Hawkins, Assistant Professor, Department of Medicine, UBC Supervisory Committee Member iii Abstract Background: Atrial fibrillation (AF) is the most common sustained arrhythmia with an estimated prevalence between 1-3%. There is a paucity of research studying the contemporary AF epidemiology and novel stroke prophylaxis pharmaceuticals for AF in Western Canada. Starting in 2011, the first direct oral anticoagulant (DOAC) drugs were approved in Canada. This thesis identifies and describes British Columbia’s (BC) AF population then explores epidemiological trends and differences in AF including incidence, prevalence, treatment preferences, and outcomes. Furthermore, age and sex differences are investigated in each endpoint to identify potential health in…
has type: Thesis/Dissertation
date issued: 2020-05
is shown at: 10.14288/1.0389635
language: eng
degree discipline: Population and Public Health
provider: Vancouver : University of British Columbia Library
publisher: University of British Columbia
rights: Attribution-NonCommercial-NoDerivatives 4.0 International
rights URI: http://creativecommons.org/licenses/by-nc-nd/4.0/
scholar level: Graduate
type: Text
identifier URI: http://hdl.handle.net/2429/73809