Introduction: The nationwide effect of significant changes in the rate of oral anticoagulation (OAC) on the mortality and admission rate of atrial fibrillation (AF) patients in the recent years is unknown.
Hypothesis: The advances in the field of AF management including wider utilization of non-vitamin K antagonist oral anticoagulants (NOAC) are related with improved time-trends for mortality and hospitalization for AF.
Methods: Between January, 2010 and December, 2015, we identified 629,102 patients with nonvalvular AF in the Korea National Health Insurance System (NHIS) database. Time-trends in OAC utilization, annual mortality and hospitalization rates were analyzed.
Results: The annual rate of anticoagulation increased by 63.7% from 14.6% (95%CI 0.145-0.147) in 2010 to 23.9% (95%CI 0.238-0.240) in 2015 (P for trend < 0.001) among eligible AF patients. The annual mortality rate decreased from 3.82% (95%CI 0.0375-0.0389) in 2010 to 2.50% (95%CI 0.0247-0.0254) in 2015, with a gradual decline during study period (P for trend < 0.001). Annual hospitalization rate decreased by 23.5% from 21.7% (95%CI 0.215-0.219) in 2010 to 18.8% (95%CI 0.187-0.189) in 2015 (P for trend < 0.001). Increased utilization of OAC was negatively correlated with the annual rate of mortality (R=-0.86, P<0.001) and hospital admission (R=-0.58, P=0.048). The decline in mortality rate was more pronounced after the introduction of NOACs (-22.1%) than before the increased NOAC utilization occurred (-17.0%).
Conclusions: Time-trends for the incidence of annual mortality and hospital admissions among Korean AF patients show a decrease in recent years. This reduction was associated with an increase in rates of OAC use, which was particularly influenced by the introduction of NOACs.