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UBC Theses and Dissertations

A study of the contemporary atrial fibrillation epidemiology and oral anticoagulation in British Columbia : a population based study Daniele, Patrick


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 population is shifting to an older, more at risk population. The broadened armamentarium of OAC agents available is being utilized and is associated with improved outcomes. The epidemiology of AF, the treatment, and outcomes of patients differ by age and sex; therefore, future research should account for age and sex differences through appropriate methodology.

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