Epidemiology, Management and Outcomes of Atrial Fibrillation Among 30 Million Medicare Subjects of Shanghai, China from 2015 to 2020

Background: Atrial fibrillation(AF) has become a significant public health concern in China, with population aging and urbanization.Methods: Data screening was performed for 30,244,930 Medicare subjects in the Shanghai Municipal Health Commission database between 2015 and 2020. Patients diagnosed with AF were identified and further assessed for treatment information and clinical outcomes.Findings: AF prevalence was 0·88% in adult (>18 years) in Shanghai, which increased with age and reached 6·70% at subjects 80 years and over. AF was more prevalent in women compared with men, which could be attributed to higher AF burden in women over 80 years. Driven by increased prescription of non-vitamin K antagonist oral anticoagulants, anticoagulant use increased from 19.46% in 2015 to 56.57% in 2020. The number of left atrial appendage closure increased from 0.16% in 2015 to 1.23% in 2020. Rhythm control strategy was increasingly adopted, as the use of antiarrhythmic drugs doubled and ablation increased by 21% in 2020 compared to 2015. Compared with men, women were less prone to receive rhythm control treatments, including antiarrhythmics, ablation and cardioversion, but more likely to adopt rate control drugs. During the 5.5 years follow-up, stroke, transient ischemic attack, systemic embolism, bleeding, and myocardial infarction were observed in 6.09%, 5.74%, 1.44%, 5.11% and 8.41% respectively in AF patients.Interpretation: The burdens of AF and AF-related outcomes in Shanghai are high. Management of AF is markedly improved in recent years, and was not or only slightly impeded by the COVID-19 pandemic. Sex differences are observed in the prevalence, management, and outcomes of AF.Funding: Shanghai Hospital Development Center, National Natural Science Foundation of China and Shanghai Municipal Science and Technology Commission.Declaration of Interest: All authors declare no conflicts of interest.Ethical Approval: This study was approved by the ethics committee of Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University.