Atrial fibrillation (AF) is an increasingly common arrhythmia in our ageing population with major economic and health consequences such as stroke and premature death. Although AF prevalence and incidence are increasing, many aspects of this new epidemic of cardiovascular disease concerning both AF occurrence, progression and management are not fully elucidated. This project aims to cover some of the important knowledge gaps and to study the natural history of AF in a Norwegian population over time with a focus on sex differences. The project is based on the population-based Tromsø Study 1986-2017 merged with the Norwegian Patient Registry and the Norwegian Prescription Database. Main advantages are the longitudinal design, repeated risk factor measurements, validated follow-up information, and the large sample size. We will explore secular trends in the incidence of AF, its clinical complications and hospitalisation rates over recent decades, and will estimate the contribution of risk factors with a special focus on such modifiable factors as hypertension and psychological aspects. The two comorbid conditions AF and heart failure frequently coexist and complicate the course and treatment of each other. The direction of cause and effect with the conditions is yet to be fully elucidated. Important is also to study the risk of stroke for AF patients related to the introduction of direct oral anticoagulants as an alternative to warfarin in Norway in 2011.
Main aim is to study the natural history of AF. The findings may identify strategies for risk lowering of AF development and outcomes and change clinical practice.
Specific aims:
• To explore incidence trends in AF and outcomes, and the impact of risk factor changes in the Tromsø Study 1986-2017
• To study the role of psychological factors and quality of life in the development of AF and outcomes
• To explore associations between blood pressure, blood pressure changes and risk of outcomes in AF patients
• To study change in stroke risk in AF patients related to the introduction of direct oral anticoagulants as an alternative to warfarin in 2011
• To investigate bidirectional associations between AF and heart failure