INTRODUCTION:We aimed to explore the potential incremental cost-effectiveness of the PRODEMOS coach-supported mobile health intervention for primary prevention of dementia versus standard of care provided to people aged 55-75 years with low socio-economic status (SES) in the United Kingdom (UK), and any SES in China. METHODS:12-18-month PRODEMOS trial (ISRCTN15986016) efficacy outcomes on hypertension, obesity, hypercholesterolemia, physical inactivity and smoking were extrapolated to lifetime impact on dementia onset, myocardial infarction, stroke and death using a health-economic open-source simulation model. RESULTS:Simulated outcomes showed dementia cases were avoided (UK = -206 (-658 to 281), China = -140 (-456 to 205) per 100,000 persons) and disease-free time was gained for dementia, myocardial infarction and stroke (mean months per person UK = 0.4, 0.0 and 0.0; China = 0.2, 0.0 and 0.0 respectively). Assuming a maximum intervention duration of 10 years with a 10 % annual non-adherence rate, the incremental net health benefit in the UK (-0.190) and China (-0.009) indicated a potential lack cost-effectiveness. LIMITATIONS:Our method was limited by strong assumptions regarding causality and sustained effectiveness, lack of some country-specific input estimates, and the lack of probabilistic analysis. CONCLUSION:The PRODEMOS coach-supported mobile health intervention for the primary prevention of dementia, aimed at people aged 55 to 75 years with low SES in the UK and those of any SES in China, may potentially lack cost-effectiveness in both countries. However, lack of data required strong assumptions regarding causality and sustained effectiveness, which limited policy recommendations.

INTRODUCTION:Residents in long-term institutional care (LTIC) settings are at risk of malnutrition, sarcopenia, and frailty. In the Older Persons Exercise and Nutrition (OPEN) randomized study, the impact of exercise and nutrition was analyzed. This secondary analysis focused on caregiver time (CGT). METHODS:The 3-month intervention included repeated sit-to-stand exercises and two protein-enriched supplements daily. CGT was assessed in both dementia and somatic units using the Resource Utilization in Dementia instrument. Non-linear methods were applied due to skewed data. RESULTS:The sample consisted of 102 persons (intervention group [IG] n = 52, control group [CG] n = 50). CGT in the IG was significantly lower at follow-up, adjusted for baseline CGT, in the dementia units, that is, 55 min/day and resident, compared to 83 min/day in the CG (odds ratio 0.668 [0.473-0.945]; p = 0.022). DISCUSSION:A structured exercise and nutrition program was associated with reduced CGT in the dementia, but not the somatic, LTIC units. CLINICAL TRIAL REGISTRATION:This study has been registered with the number protocol of ClinicalTrials.gov Identifier: NCT02702037.

Background The introduction of anti-amyloid treatments (AAT) for Alzheimer's disease (AD) has put the cost-effectiveness into focus. Objective Estimate the potential cost-effectiveness of diagnostic pathways combined with AAT for early AD. Methods Diagnostic accuracy of blood-based (BBM) and cerebrospinal fluid (CSF) biomarkers was obtained from Norwegian memory clinics using positron emission tomography (PET) as reference standard. In a health-economic model, the cost-effectiveness of three diagnostic strategies was estimated relying either on BBM (p-tau 217), CSF (Aβ 42/40 ratio), and BBM with CSF confirmatory testing and compared with standard of care (SoC) and compared with CSF-AAT. The model consisted of a decision tree reflecting the diagnostic process and a subsequent Markov cohort model starting at mild cognitive impairment due to AD. All strategies except SoC were combined with AAT including costs of treatment (assumed €5000/year), infusions and monitoring. Results Compared with SoC all three strategies (CSF-AAT, BBM-AAT, and BBM-CSF-AAT) resulted in QALY gains at higher costs, with an incremental cost-effectiveness ratio (ICER) of 110k€, 141k€ and 110k€ respectively. Compared with CSF-AAT both BBM-AAT and BBM-CSF-AAT strategies resulted in QALYs lost at lower costs, with an ICER of 27k€ and 109k€ respectively. Results were particularly sensitive to the price of AAT and possible subcutaneous administration. Conclusions Compared with SoC all three strategies are potentially not cost-effective as they exceeded the Swedish maximum willingness to pay threshold of €94,800 per QALY gained. BBM-CSF-AAT versus CSF-AAT is potentially cost-effective if willing to accept its QALY loss. Discussions on budget impact on different payers are needed after introducing AAT.

BackgroundThe Models of Patient Engagement for Alzheimer's Disease (MOPEAD) project aimed to identify the most effective and cost-efficient recruitment model for detecting prodromal and mild Alzheimer's disease (AD) across five European countries.ObjectiveTo examine differences in cardiovascular risk factors and cognitive performance among countries and recruitment models using MOPEAD data.MethodsIndividuals aged 65-85 with a high risk for prodromal or mild AD were included. Four recruitment models were used: a web-based screening tool, an open house initiative (OHI), a primary care-based protocol for early detection of cognitive decline, and a tertiary care-based screening at a diabetologist clinic. Participants from Germany, Spain, the Netherlands, Sweden, and Slovenia were recruited. Cardiovascular risk factors were self-reported, and cognition was assessed using The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).ResultsA total of 414 individuals (mean age 71.9, SD = 5.0) were included. Significant differences were observed in physical activity (p < 0.001), with individuals from Sweden and Slovenia being the most active. Dutch participants scored highest on most cognitive measures. Individuals recruited via web-based survey were youngest, most active (61.7%), and had the lowest rates of diabetes (12.0%) and heart disease (6.4%), as well as the best cognitive scores. Those recruited via diabetologist clinics displayed the highest cardiovascular risk and the lowest cognitive performance.ConclusionsThis study unveils significant disparities in cardiovascular health and cognition across recruitment strategies and European countries. The OHI shows promise for future recruitment in the context of disease-modifying AD treatments.

Introduction Informal care estimates for use in health-economic models are lacking. We aimed to estimate the association between informal care time and dementia symptoms across Europe. Methods A secondary analysis was performed on 13,529 observations in 5,369 persons from 9 European pooled cohort or trial studies in community-dwelling persons with dementia. A mixed regression model was fitted to time spent on instrumental or basic activities of daily living using disease severity and demographic characteristics. Results Daily informal care time was 0.5 hours higher in moderate compared to mild and 1.3h higher in severe compared to mild cognitive impairment. Likewise, this was 1.2h and 2.7h for functional disability and 0.3h and 0.6h for behavioral symptoms in the same directions. Discussion Estimates can be used in both single- and multi-domain health-economic models for dementia in European settings.

Objectives: Decision-analytic models assessing the value of emerging Alzheimer's disease (AD) treatments are challenged by limited evidence on short-term trial outcomes and uncertainty in extrapolating long-term patient-relevant outcomes. To improve understanding and foster transparency and credibility in modeling methods, we cross-compared AD decision models in a hypothetical context of disease-modifying treatment for mild cognitive impairment (MCI) due to AD. Methods: A benchmark scenario (US setting) was used with target population MCI due to AD and a set of synthetically generated hypothetical trial efficacy estimates. Treatment costs were excluded. Model predictions (10-year horizon) were assessed and discussed during a 2-day workshop. Results: Nine modeling groups provided model predictions. Implementation of treatment effectiveness varied across models based on trial efficacy outcome selection (clinical dementia rating-sum of boxes, clinical dementia rating-global, mini-mental state examination, functional activities questionnaire) and analysis method (observed severity transitions, change from baseline, progression hazard ratio, or calibration to these). Predicted mean time in MCI ranged from 2.6 to 5.2 years for control strategy and from 0.1 to 1.0 years for difference between intervention and control strategies. Predicted quality-adjusted life-year gains ranged from 0.0 to 0.6 and incremental costs (excluding treatment costs) from 2US$66 897 to US$11 896. Conclusions: Trial data can be implemented in different ways across health-economic models leading to large variation in model predictions. We recommend (1) addressing the choice of outcome measure and treatment effectiveness assumptions in sensitivity analysis, (2) a standardized reporting table for model predictions, and (3) exploring the use of registries for future AD treatments measuring long-term disease progression to reduce uncertainty of extrapolating short-term trial results by health-economic models.

The advancement of disease-modifying treatments (DMTs) for Alzheimer's disease (AD), along with the approval of three amyloid-targeting therapies in the US and several other countries, represents a significant development in the treatment landscape, offering new hope for addressing this once untreatable chronic progressive disease. However, significant challenges persist that could impede the successful integration of this class of drugs into clinical practice. These challenges include determining patient eligibility, appropriate use of diagnostic tools and genetic testing in patient care pathways, effective detection and monitoring of side effects, and improving the healthcare system's readiness by engaging both primary care and dementia specialists. Additionally, there are logistical concerns related to infrastructure, as well as cost-effectiveness and reimbursement issues.This article brings together insights from a diverse group of international researchers and dementia experts and outlines the potential challenges and opportunities, urging all stakeholders to prepare for the introduction of DMTs. We emphasize the need to develop appropriate use criteria, including patient characteristics, specifically for the European healthcare system, to ensure that treatments are administered to the most suitable patients. It is crucial to improve the skills and knowledge of physicians to accurately interpret biomarker results, share decision-making with patients, recognize treatment-related side effects, and monitor long-term treatment. We advocate for investment in patient registries and unbiased follow-up studies to better understand treatment effectiveness, evaluate treatment-related side effects, and optimize long-term treatment. Utilizing amyloid-targeting therapies as a starting point for combination therapies should also be a priority.

Background Blood biomarkers with prognostic accuracy for Alzheimer's disease (AD) are crucial for selecting at-risk individuals for interventions. Altered protein N-glycosylation has been implicated in several pathogenic pathways in AD and could be an early AD biomarker. Methods We developed a mass spectrometry-based method to simultaneously quantify 62 blood N-glycan structures in individuals with biological or clinical AD and matched controls. We analysed N-glycan levels in a Swedish discovery cohort (n = 40) and validated our results in a Norwegian cohort (n = 60). Individuals were grouped according to N-glycan levels using unsupervised hierarchical clustering. Difference in disease progression between groups were modelled using linear mixed-effects models. Findings A subgroup of individuals exhibited low blood N-glycosylation (32.4% of Swedish cohort, 37.9% of Norwegian cohort). In the Swedish cohort, low N-glycosylation was associated with AD and cognitive decline. In the Norwegian cohort, low blood N-glycosylation showed no correlation with amyloid/tau, but importantly, strongly predicted future cognitive decline. In total, fourteen N-glycan structures were significantly less abundant in the low N-glycosylation group compared to the rest of the individuals in both cohorts. Interpretation Reduced blood N-glycan levels predict cognitive decline independent of amyloid or tau status. Blood N-glycome profiling could be used to identify individuals at risk for AD dementia.

ABSTRACTObjectivesMarket access and reimbursement decisions for new Alzheimer’s disease (AD) treatments are informed by economic evaluations. An open-source model with intuitive structure for model cross-validation can support the transparency and credibility of such evaluations. We describe the new IPECAD open-source model framework (version 2) for the health-economic evaluation of early AD treatment and use it for cross-validation and addressing uncertainty.MethodsA cohort state transition model using a categorized composite domain (cognition and function) was developed by replicating an existing reference model and testing it for internal validity. Then, features of existing “ICER” and “AD-ACE” models assessing lecanemab treatment were implemented for model cross-validation. Additional uncertainty scenarios were performed on choice of efficacy outcome from trial, natural disease progression, treatment effect waning and stopping rules, and other methodological choices. The model is available open-source as R code, spreadsheet and web-based version viahttps://github.com/ronhandels/IPECAD.ResultsIn the IPECAD model incremental life years, QALY gains and cost savings were 21-31% smaller compared to the ICER model and 36-56% smaller compared to the AD-ACE model. IPECAD model results were particularly sensitive to assumptions on treatment effect waning and stopping rules and choice of efficacy outcome from trial.ConclusionsWe demonstrated the ability of a new IPECAD opens-source model framework for researchers and decision-makers to cross-validate other (HTA submission) models and perform additional uncertainty analyses, setting an example for open science in AD decision modeling and supporting important reimbursement decisions.

We sought to estimate the cost-effective price for lecanemab for treating early Alzheimer's disease in Sweden from the perspective of formal care payers. We developed a Markov model with states defined by disease severity and care setting. The model was populated by integrated clinical and economic data from Swedish registers. We included patients with biomarker-confirmed Alzheimer's disease and fitted survival models for transitions between model states. Costs in 2023 Swedish kronor (SEK), life-years (LYs), and quality-adjusted LYs (QALYs) over a 10-year time horizon were estimated for standard of care and for lecanemab in addition to standard of care, assuming a maximum treatment duration of 3 years with lecanemab and no treatment effect after treatment stops. We also explored the impact of different assumptions regarding treatment efficacy and duration. Treatment with lecanemab over 3 years resulted in 0.13 LYs gained, 0.17 QALYs gained, and a net cost increase of 87,146 SEK (€1 = 11.5 SEK, $US1 = 10.6 SEK) due to administration and monitoring, before considering the cost of drug. The cost-effective price of lecanemab at a willingness-to-pay level of 1 million SEK per QALY was 33,886 SEK per year of treatment. The health gain, net costs, and cost-effective price of lecanemab varied significantly by treatment duration, potential residual effects, and patient characteristics. The future price of lecanemab in European countries is unknown. However, treatment with lecanemab is unlikely to be cost effective in Sweden at the levels of current list prices in the USA.

It is increasingly clear that aberrant N-glycosylation of proteins is an early pathogenic trigger in Alzheimer’s disease (AD). Thus, we hypothesized that determination of the blood N-glycome could reveal AD-specific glycomic patterns, especially in early stages of the disease. For N-glycan quantification in blood, we developed a method based on porous graphite carbon liquid chromatography coupled to tandem mass spectrometry (PGC-LC-MS/MS). We simultaneously determined levels of 62 N-glycan structures in 100 individuals from two different cohorts. In the Swedish National Study on Aging and Care in Nordanstig (SNAC-N) cohort, we analyzed blood samples from 40 age- and sex-matched AD and control individuals. In the Norwegian Dementia Disease Initiation (DDI) cohort, we analyzed blood samples from 60 individuals from A-T-, A+T-, and A+T+ biomarker groups, matched by age, sex, and education. In the Swedish SNAC-N discovery cohort, a specific blood signature of low levels of a group of N-glycans was associated with AD dementia, lower cognitive function, as well as higher levels of AD biomarkers such as blood pTau217. In the Norwegian DDI cohort, a similar low N-glycosylation blood signature was associated with APOE4 genotype and future cognitive decline, but not with A/T status. In short, low levels of 14 N-glycan structures were associated with poor cognitive outcome in both cohorts. Here, we provided an extensive characterization of the blood N-glycome in AD. We showed that the blood N-glycome could predict cognitive decline in an amyloid/tau independent manner. Blood N-glycomics should be further developed as a minimally invasive prognostic biomarker in early stages of dementia.

Novel anti-amyloid therapies (AAT) for Alzheimer’s Disease (AD) have recently been approved in the United States, Japan and China, and are under regulatory review in Europe. Questions remain regarding the long-term effectiveness and value of these drugs when used in routine clinical practice. Data from follow-up studies will be important to inform their optimal use, including criteria for treatment initiation, monitoring strategies, stopping rules, pricing and reimbursement considerations. Newly initiated treatment registries will only or mainly enroll patients receiving AAT with no control arm - for comparisons with of health outcomes in untreated patients, external historic control data will be required. We reviewed the literature to identify disease registries with relevant design and inclusion criteria.Patient-level data was obtained from two registries deemed to be promising as sources of historic control data: the Swedish Registry for Cognitive Disorders (SveDem) and the National Alzheimer’s Coordinating Centers (NACC). From these registries we selected patients fulfilling key criteria for treatment with AAT and analyzed longitudinal data on relevant endpoints (disease progression, functional status and mortality) using survival analysis methods. Sample size requirements for evaluating the effect of AAT on these endpoints were estimated using the Lachin & Foulkes method assuming a risk ratio of 0.7 with treatment. 35 disease registries were identified from 15 countries. Many did not include the relevant patient populations, endpoints or had insufficient follow-up. From SveDem and NACC, 1378 and 7392 patients respectively were included, respectively. The median time to disease progression was 1.9-3.2 years, time to full-time care 2.7-5.3 years, and median overall survival 11.4-13.6 years. Approximately 248 events would be required to detect a difference in time to event with 80% power. In SveDem, a total number of 2717 disease progression events, 3916 full-time care events and 842 mortality events were observed. Follow-up studies will be of key importance for confirming the clinical effectiveness and economic value of DMT in routine care. Established registry infrastructures with available historic datasets will play an important role. International collaboration may be needed to achieve sufficient sample size for assessment effects on some endpoints, such as overall survival.

BACKGROUND:Informal caregiving is a crucial-albeit often invisible-part of the support system that enables older people with chronic diseases, disability, or age-related conditions to live in the community. However, providing informal care can affect caregivers' lives. AIMS:To explore 1) the level of care intensity among older caregivers, 2) the relationship between the intensity of caregiving and the negative experiences reported by caregivers, and 3) the variations in unmet support needs depending on the intensity of caregiving. METHODS:Between May and September 2023, we conducted a national representative survey to map informal caregivers in Sweden. A total of 25,776 older adults aged ⩾65 years were sampled. Marginal probabilities were calculated to obtain results adjusted for age, sex, and level of education. RESULTS:A total of 15,129 people aged ⩾65 years responded to the survey (58.7%), of which 2157 were informal caregivers (14.3%). During a typical week, 68.6% of caregivers provided 1-10 h of informal care, 14.6% provided 11-29 h, and 16.8% provided at least 30 h of care. Women (63.1%) and caregivers aged ⩾75 years (64.1%) were overrepresented in the group providing high-intensity informal care. A higher intensity of care was related to reporting more negative experiences and worse health, as well as to experiencing more unmet support needs. CONCLUSIONS:While most older informal caregivers reported low-intensity engagement and overall good satisfaction with their situation, a non-negligible fraction provides high-intensity help and has unmet needs that should be addressed by targeted interventions rather than one-size-fits-all policies.

β-amyloid-targeting antibodies represent the first generation of effective causal treatment of Alzheimer’s disease (AD) and can be considered historical research milestones. Their effect sizes, side effects, implementation challenges and costs, however, have stimulated debates about their overall value. In this position statement academic clinicians of the European Alzheimer’s Disease Consortium (EADC) discuss the critical relevance of introducing these new treatments in clinical care now. Given the complexity of AD it is unlikely that molecular single-target treatments will achieve substantially larger effects than those seen with current β-amyloid-targeting antibodies. Larger effects will most likely only be achieved incrementally by continuous optimization of molecular approaches, patient selection and combinations therapies. To be successful in this regard, drug development must be informed by the use of innovative treatments in real world practice, because full understanding of all facets of novel treatments requires experience and data of real-world care beyond those of clinical trials. Regarding the antibodies under discussion we consider their effects meaningful and potential side effects manageable. We assume that the number of eventually treated patient will only be a fraction of all early AD patients due to narrow eligibility criteria and barriers of access. We strongly endorse the use of these new compound in clinical practice in selected patients with treatment documentation in registries. We understand this as a critical step in advancing the field of AD treatment, and in shaping the health care systems for the new area of molecular-targeted treatment of neurodegenerative diseases.

BACKGROUND:The expected increase of dementia prevalence in the coming decades will mainly be in low-income and middle-income countries and in people with low socioeconomic status in high-income countries. This study aims to reduce dementia risk factors in underserved populations at high-risk using a coach-supported mobile health (mHealth) intervention. METHODS:This open-label, blinded endpoint, hybrid effectiveness-implementation randomised controlled trial (RCT) investigated whether a coach-supported mHealth intervention can reduce dementia risk in people aged 55-75 years of low socioeconomic status in the UK or from the general population in China with at least two dementia risk factors. The primary effectiveness outcome was change in cardiovascular risk factors, ageing, and incidence of dementia (CAIDE) risk score from baseline to after 12-18 months of intervention. Implementation outcomes were coverage, adoption, sustainability, appropriateness, acceptability, fidelity, feasibility, and costs assessed using a mixed-methods approach. All participants with complete data on the primary outcome, without imputation of missing outcomes were included in the analysis (intention-to-treat principle). This trial is registered with ISRCTN, ISRCTN15986016, and is completed. FINDINGS:Between Jan 15, 2021, and April 18, 2023, 1488 people (601 male and 887 female) were randomly assigned (734 to intervention and 754 to control), with 1229 (83%) of 1488 available for analysis of the primary effectiveness outcome. After a mean follow-up of 16 months (SD 2·5), the mean CAIDE score improved 0·16 points in the intervention group versus 0·01 in the control group (mean difference -0·16, 95% CI -0·29 to -0·03). 1533 (10%) invited individuals responded; of the intervention participants, 593 (81%) of 734 adopted the intervention and 367 (50%) of 734 continued active participation throughout the study. Perceived appropriateness (85%), acceptability (81%), and fidelity (79%) were good, with fair overall feasibility (53% of intervention participants and 58% of coaches), at low cost. No differences in adverse events between study arms were found. INTERPRETATION:A coach-supported mHealth intervention is modestly effective in reducing dementia risk factors in those with low socioeconomic status in the UK and any socioeconomic status in China. Implementation is challenging in these populations, but those reached actively participated. Whether this intervention will result in less cognitive decline and dementia requires a larger RCT with long follow-up. FUNDING:EU Horizon 2020 Research and Innovation Programme and the National Key R&D Programmes of China. TRANSLATION:For the Mandarin translation of the abstract see Supplementary Materials section.

OBJECTIVES:The implementation of disease-modifying treatments for Alzheimer's Disease (AD) will require cost-effective diagnostic processes. As part of The Precision Medicine In AD consortium (PMI-AD) project, the aim is to analyze the baseline costs of diagnosing early AD at memory clinics in Norway, Slovenia, and the Netherlands. METHODS:The costs of cognitive testing and a clinical examination, apolipoprotein E, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF), positron emission tomography and blood-based biomarkers (BBM), which are used in different combinations in the three countries, were analyzed. Standardized unit costs, adjusted for GDP per capita and based on Swedish conditions were applied. The costs were expressed in euros (€) as of 2019. A diagnostic set comprising clinical examination, cognitive testing, MRI and CSF was defined as the gold standard, with MRI mainly used as an exclusion filter. RESULTS:Cost data were available for 994 persons in Norway, 169 in Slovenia and 1015 in the Netherlands. The mean diagnostic costs were 1478 (95% confidence interval 1433-1523) € in Norway, 851 (731-970) € in Slovenia and 1184 (1135-1232) € in the Netherlands. Norway had the highest unit costs but also the greatest use of tests. With a uniform diagnostic test set applied, the diagnostic costs were 1264 (1238-1291) €, in Norway, 843 (771-914) € in Slovenia and 1184 (1156-1213) € in the Netherlands. There were no major cost differences between the final set of diagnoses. CONCLUSIONS:The total costs for setting a diagnosis of AD varied somewhat in the three countries, depending on unit costs and use of tests. These costs are relatively low in comparison to the societal costs of AD.

Abstract Background As global aging accelerates, routinely assessing the functional status and morbidity burden of older patients becomes paramount. The aim of this study is to assess the validity of the comprehensive clinical and functional Health Assessment Tool (HAT) based on four cohorts of older adults (60 + years) from the Swedish National study on Aging and Care (SNAC) spanning urban, suburban, and rural areas. Methods The HAT integrates five health indicators (gait speed, global cognition, number of chronic diseases, and basic and instrumental activities of daily living), providing an individual-level score between 0 and 10. The tool was constructed using nominal response models, first separately for each cohort and then in a harmonized dataset. Outcomes included all-cause mortality over a maximum follow-up of 16 years and unplanned hospital admissions over a maximum of 3 years of follow-up. The predictive capacity was assessed through the area under the curve (AUC) using logistic regressions. For time to death, Cox regressions were performed, and Harrell’s C-indices were reported. Results from the four cohorts were pooled using individual participant data meta-analysis and compared with those from the harmonized dataset. Results The HAT demonstrated high predictive capacity across all cohorts as well as in the harmonized dataset. In the harmonized dataset, the AUC was 0.84 (95% CI 0.81–0.87) for 1-year mortality, 0.81 (95% CI 0.80–0.83) for 3-year mortality, 0.80 (95% CI 0.79–0.82) for 5-year mortality, 0.69 (95% CI 0.67–0.70) for 1-year unplanned admissions, and 0.69 (95% CI 0.68–0.70) for 3-year unplanned admissions. The Harrell’s C for time-to-death throughout 16 years of follow-up was 0.75 (95% CI 0.74–0.75). Conclusions The HAT is a highly predictive, clinically intuitive, and externally valid instrument with potential for better addressing older adults’ health needs and optimizing risk stratification at the population level.

Objective: This study examined the prevalence and long-term survival of atrial fibrillation (AF) in the older population. Methods: Data was recruited from the longitudinal SNAC study from baseline (2001–2004) for up to 10 years. Results: The population comprised 6,904 persons (59% women) (mean age 73.9 years). The prevalence of AF was 4.9% and increased with age. The hazard ratio (HR) for death in those with AF at baseline was 1.29 during the 10-year observation period. Cox regression analysis in persons with AF ( n = 341) showed that men had a higher HR for death (1.57). CHA2DS2-VASc scores were significantly associated with death within 10 years (HR 1.29/score). Any form of anticoagulant use was reported in 146 (42.8%) and was significantly associated with survival ( p = .031). Conclusions: The prevalence of AF in the general population was almost 5%, and it shortened life expectancy by nearly 2.4 years over a 10-year period. Despite the proven efficacy of OAC therapies, our results demonstrate that AF continues to be associated with increased mortality, especially among men, and that many older people are at high risk of developing a stroke because they do not receive appropriate anticoagulant therapy. These results emphasize the need for improved preventive and therapeutic modalities.