BACKGROUND:Limited data exist on characteristics and patterns associated with patients with atrial fibrillation (AF) who encounter first-ever ischemic stroke (IS) while not on oral anticoagulation (OAC) therapy. METHODS:From a nationwide registry-linkage database including all patients with AF in Finland from 2007 to 2017, we included those with IS after diagnosis of AF and those without IS. Factors associated with non-OAC use among IS patients were examined using logistic regression, with separate models for independent variables and risk scores. RESULTS:Among 174,094 patients with new-onset AF, 11,680 (6.7%) patients (56.9% female; mean age 79.0 years) experienced IS. A total of 7507 (64.3%) of IS patients were not on OAC at the time of IS (mean age 78.9 years; 57.2% female). The proportion of non-OAC decreased from 77.2% to 45.6% over the study period. In the adjusted logistic regression model, the strongest factor associated with non-OAC was CHA2DS2-VA score of 0 points (OR 4.561; 95% CI, 3.097-6.718), followed by a score of 1 point (OR 2.382; 95% CI, 1.971-2.879). Other significant independent factors associated with non-OAC use were alcohol abuse (OR 2.282; 95% CI, 1.805-2.885), liver dysfunction (OR 2.120; 95% CI, 1.335-3.367), renal dysfunction (OR 1.430; 95% CI, 1.200-1.703), dementia (OR 1.394; 95% CI, 1.227-1.583), prior myocardial infarction (OR 1.346; 95% CI, 1.181-1.535), age <65 years (OR 1.274; 95% CI, 1.034-1.571), lowest income (OR 1.232; 95% CI, 1.104-1.374), female sex (OR 1.177; 95% CI, 1.077-1.287), and antiplatelets/NSAID use (OR 1.133; 95% CI, 1.042-1.231). CONCLUSIONS:Less than 2% of AF patients experienced IS during study period and among these around 63% were without appropriate OAC therapy at the time of the IS. However, decreasing trend of non-OAC use was identified throughout the study period.

The cost burden of new-onset atrial fibrillation (AF) has not previously been studied with unselected nationwide data. We analyzed differences in the distribution and time course of costs from all categories of healthcare services in patients receiving direct oral anticoagulants (DOACs), warfarin, or no anticoagulation during the first year following diagnosis of AF. This sub-study of the Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) project comprised all new-onset AF patients from 2011 to 2017 in Finland with an indication for oral anticoagulation treatment. The registry data included information on primary and secondary care services as well as social care services, drug purchases, laboratory data, and reimbursed private care and travel services. We report inverse probability of treatment weighted average costs for different pharmaceutical groups with bootstrapped confidence intervals. In total, 130,745 patients (66,610 on warfarin, 32,996 on DOACs) were included. Weighted first-year costs after onset of AF were €11,364 for rivaroxaban (n = 13,230), €12,642 for apixaban (n = 11,886), €11,403 for dabigatran (n = 7514), and €10,752 for edoxaban (n = 366). Costs were clustered near the diagnosis of AF. Costs for warfarin patients were inversely related to the quality of anticoagulation therapy. Average first-year costs for warfarin patients were €15,860, higher than for patients on DOACs by €3218–€5108. Patients without any oral anticoagulation had the highest first-year costs, €17,682. Patients with high risk of stroke had higher total costs, both in patients using DOACs and warfarin. DOACs had lower total costs than warfarin despite higher drug expenses. Patients without any oral anticoagulation had the highest costs. NCT04645537. EUPAS29845.

BACKGROUND:Patients with atrial fibrillation (AF) are often treated with antiarrhythmic drugs (AADs) to maintain sinus rhythm and with heart rate-lowering drugs to achieve the optimal rate control. In this study, we investigated trends in the use of AADs and rate control drugs in Finnish patients with AF. METHODS AND RESULTS:The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study is a nationwide study including all patients with AF in Finland from 2007 to 2018. The number of AAD purchases and the proportions of all prevalent AF patients in a certain year of interest were calculated. In total, 391030 AF patients were identified between 2007 and 2018, and 39,816 (10.2%) of them had purchased either class I or III AADs. The proportion of patients using classes I and III AADs decreased from 8.6% to 6.3%. Flecainide and amiodarone were the most often used AADs. The use of flecainide and amiodarone decreased from 4.9% to 3.9% and 1.9% to 1.5%, respectively. The proportion of patients on beta-blockers remained stable at 75%. Dronedarone became available in 2011 when it also was the most used (0.8% of patients), but the use decreased thereafter. The use of sotalol and digoxin decreased from 1.5% to 0.6% and 24.6% to 11.0% over the study period. CONCLUSION:The number of AAD purchases increased alongside with the increasing prevalence of AF, whereas the proportion of AF patients on classes I and III AADs and digoxin decreased between 2007 and 2018. Flecainide remained the most used AAD followed by amiodarone.

Background:Unidentified cardiovascular risk factors may account for approximately half of sudden deaths, a devastating event with limited preventive tools. We investigated whether adrenal histopathology suggestive of primary aldosteronism, pheochromocytoma, or adrenal masses could explain part of the risk for disease-induced sudden death (DSD). Methods:In this study, autopsies and histopathological analyses, including aldosterone synthase staining of adrenal glands, were performed on 403 consecutive individuals who experienced sudden death. These individuals were classified into 258 cases of DSD and 144 deaths caused by trauma, suicide, or intoxication, i.e., non-disease-induced sudden death (nDSD). This trial was registered at ClinicalTrials.gov (NCT05446779). Findings:Adrenal histopathology revealed changes in 31 (7.7%) subjects of the cohort. Of these, the most prevalent findings [25 (6.2%)] were aldosterone-producing adenomas (APA) or nodules (APN), which were associated with myocardial infarction and atherosclerosis at autopsy. Individuals in the DSD group and the subgroup with sudden cardiac death (SCD) were more likely to have APA or APN than individuals in the nDSD group [23 (8.9%) vs. 2 (1.4%), p = 0.002; 16 (8.8%) vs. 2 (1.4%), p = 0.003, respectively]. APA or APN were explanatory factors for DSD (odds ratio [OR] 6.47, 95% confidence interval [CI] 1.40-29.88, p = 0.017) and SCD (OR 10.68, 95% CI 2.02-56.43, p = 0.005). Other findings included two pheochromocytomas, one bilateral adrenal metastasis, and two unilateral adrenal metastases. Interpretation:In this exploratory study, APA or APN were more frequently seen in DSD and SCD than nDSD cases. Whether primary aldosteronism constitutes a novel risk factor for sudden death warrants further study. Funding:Finnish State Research funds and independent research foundations: Aarne Koskelo Foundation, the Finnish Kidney Foundation, and the Finnish Foundation for Cardiovascular Research.

Background Despite increased atrial fibrillation (AF) and oral anticoagulation (OAC) use among patients with intracerebral hemorrhage, trends in hemorrhagic stroke (HS) incidence in AF remain unclear. We examined recent epidemiological trends, considering advances in stroke prevention and an aging population. Methods and Results A Finnish nationwide study using linked administrative registries followed 168 121 patients with incident AF (2009–2017) until the first‐ever intracerebral or subarachnoid hemorrhage, death, or study end (November 2018). HS incidence rates, the proportion of fatal cases (case fatality rate %), and anticoagulant purchases within 90 days before HS were analyzed. Temporal trends were assessed using logistic and Poisson regression. A total of 1890 patients with AF (53% women, median age 80.2) experienced their first‐ever HS. The average annual incidence rate was 2.82/1000 PY (95% CI, 2.72–2.92), remaining stable over 10 years (range 2.62–3.22). Age‐standardized incidence rates were 2.65 (2.48–2.82) for women and 2.94 (2.70–3.15) for men. The annual case fatality rate averaged 46.5% (43.9%–49.1%) without notable temporal or sex differences. Older age was associated with higher incidence rates and case fatality rate, with an increasing proportion of patients over 84. Prior OAC use increased: in 2009, 67% were not on OACs but by 2018, one third used warfarin, one third direct OACs, and only one third were without any OAC. No association was found between anticoagulation and HS case fatality. Conclusions Among the population with incident AF, we observed a stable first‐ever HS incidence rate and short‐term case fatality over the past decade despite a marked increase in prior oral anticoagulation use and aging.

Catheter ablation is a well-established treatment to prevent atrial fibrillation (AF) recurrences and to relieve symptoms. More information is needed on the occurrence of adverse events following the procedure. We investigated the incidence of new-onset adverse events after first-time AF catheter ablation procedures in Finland between 2012-2016. Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) is a registry-linkage study including all patients with AF in Finland between 2007-2018. A total of 3075 first-time AF ablations were identified between 2012-2016. The mean age of the patients was 57.8 years, 70.6 % were men, and the mean CHA2DS2-VA score was 1.4. All-cause mortality was 0.1% (2 patients) at the three-month follow-up and 0.3% (9 patients) at the two-year follow-up. At the three-month follow-up, 71 (2.3%) patients had suffered a new-onset adverse event, including major bleeding, myocardial infarction, heart failure, ischaemic stroke or TIA, pericardial complication (including pericarditis, hemopericardium, or the need for pericardiocentesis or surgical pericardiotomy), pneumo- or hemothorax, or death from any cause (Figure 1, Table 1). Moreover, during the two-year follow-up, 217 (7.1%) patients experienced at least one of the aforementioned adverse events. When examined with binary logistic regression analysis, age 70 years or older, hypertension, and previous ischaemic stroke or TIA at baseline were associated with the occurrence of new-onset heart failure at the two-year follow-up and diabetes was associated with new-onset heart failure at the three-month follow-up (Table 2). Furthermore, previous heart failure was related to higher odds of new-onset major bleeding whereas previous major bleeding was linked to new-onset myocardial infarction at the two-year follow-up. Additionally, being 70 years or older was associated with an increased risk of death from any cause during the two-year follow-up. Sex was not associated with adverse events after AF ablation. Catheter ablation for AF proved to be a safe treatment in terms of short-term complications. However, at the two-year follow-up, 7.1% of the patients treated with first-time AF ablation developed a new-onset adverse event. This highlights the need for continuous post-procedural monitoring and evaluation of long-term outcomes, especially in elderly patients and those with hypertension, previous stroke or TIA, bleedings, and heart failure.

BACKGROUND AND AIMS:Female sex has been linked with higher risk of ischaemic stroke (IS) in atrial fibrillation (AF), but no prior study has examined temporal trends in the IS risk associated with female sex.METHODS:The registry-linkage Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study included all patients with AF in Finland from 2007 to 2018. Ischaemic stroke rates and rate ratios were computed.RESULTS:Overall, 229 565 patients with new-onset AF were identified (50.0% women; mean age 72.7 years). The crude IS incidence was higher in women than in men across the entire study period (21.1 vs. 14.9 events per 1000 patient-years, P < .001), and the incidence decreased both in men and women. In 2007-08, female sex was independently associated with a 20%-30% higher IS rate in the adjusted analyses, but this association attenuated and became statistically non-significant by the end of the observation period. Similar trends were observed when time with and without oral anticoagulant (OAC) treatment was analysed, as well as when only time without OAC use was considered. The decrease in IS rate was driven by patients with high IS risk, whereas in patients with low or moderate IS risk, female sex was not associated with a higher IS rate.CONCLUSIONS:The association between female sex and IS rate has decreased and become non-significant over the course of the study period from 2007 to 2018, suggesting that female sex could be omitted as a factor when estimating expected IS rates and the need for OAC therapy in patients with AF.

Type 2 diabetes is associated with a high risk of sudden cardiac death (SCD), but the risk of dying from another cause (non-SCD) is proportionally even higher. The aim of the study was to identify easily available ECG-derived features associated with SCD, while considering the competing risk of dying from non-SCD causes. In the SURDIAGENE (Survie, Diabete de type 2 et Genetique) French prospective cohort of individuals with type 2 diabetes, 15 baseline ECG parameters were interpreted among 1362 participants (mean age 65 years; HbA1c 62±17 mmol/mol [7.8±1.5

Background: Catheter ablation is a well-established treatment to prevent atrial fibrillation (AF) and atrial flutter (AFL) recurrences and to relieve symptoms, whereas pacemaker implantation and atrioventricular node (AVN) ablation is used for rate control when medical therapy fails. Aims: We investigated temporal trends and patient characteristics in catheter ablation procedures for AF, AFL and AVN in Finland between 2012–2018. Methods: Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) is a registry-based study including all patients with AF or AFL in Finland between 2012–2018. Results: The number of patients with AF or AFL diagnosis in Finland increased from 185 057 to 243 802 between 2012–2018 and a total of 8954 first-time catheter ablation procedures were performed. Of them, 4909 (54.8 %) were AF ablations, 2731 (30.5 %) AFL ablations and 1314 (14.7 %) AVN ablations. The procedural numbers increased from 457/year to 934/year for AF, from 223/year to 553/year for AFL and from 114/year to 238/year for AVN. Altogether, 0.65% of all patients with diagnosed AF or AFL underwent AF, AFL or AVN ablation in 2018. The mean age of the patients increased in all ablation groups. Patients undergoing AF and AFL ablations were predominantly men (69.7 % and 74.6 % respectively) whereas patients undergoing AVN ablation were more often women (56.9%). Conclusions: The use of catheter ablation more than doubled during 2012–2018 and the increase was particularly seen in the elderly patients. Nevertheless, only a minority of AF and AFL patients were treated with catheter ablations.

Abstract Introduction The prevalence of atrial fibrillation (AF) is strongly associated with age, and with increasing life expectancy worldwide, the number of AF patients has been steadily rising. However, long-term projections of AF prevalence are scarse. Purpose To predict the prevalence and the number of patients with AF in Finland from 2021 until 2070. Methods In the Finnish Anticoagulation in Atrial Fibrillation (FinACAF) study we gathered data of all AF patients from all national health care registers (hospitalizations and outpatient specialist visits, primary health care contacts, and reimbursements for prescription medicines) from 2004 to 2018. The prevalence of AF on December 31st 2018 was calculated as the number of patients alive with AF divided by the number of Finnish population. We utilized age- and sex-specific prevalences on year 2018 to predict the prevalence by sex and 5-year age groups, using a 1-year time interval of AF in Finland between years 2021 and 2070. We obtained the projection for population structure in Finland between 2021 and 2070 from Statistics Finland. The prevalences in 2070 are provided for population ≥20 years as well as for populations ≥65 years, ≥75 years, and ≥85 years. Results In 2018, a total of 226 847 patients with the diagnosis of AF were documented in Finland. The number of adult patients with AF is predicted to increase strongly up to 2040 with a slower increase from 2040 to 2060, and again a faster increase is estimated from 2060 up to our final estimation of 2070. In total, the number of AF patients will increase with 60% until the year 2070. In 2021, prevalence of AF was 5.5% in adults and prevalence rate will increase to 8.6% in 2070. Proportion of men will be from 54.7 % to 56.0%, and the prevalence will be higher in men compared to women in all age groups with the exception in the age group ≥85 years. Among the population ≥65 years the prevalence in 2070 will be 19.7 %, and in the elderly, ≥75 years, the prevalence of AF will 25.6% and in the oldest, ≥85 years, 31.7%. In 2070 73.3 % of patients with AF are over 75 years, and 38.8% are over 85 years old. Conclusions Drawing upon extensive nationwide data covering all levels of care, our estimates indicate a continual rise in the number of AF patients in Finland until the year 2070. Notably, throughout the projected period, there is a discernible increase in the proportion of older and the oldest patients, highlighting the demographic shift in AF prevalence.Patients with AF 2021-2070 in Finland

BACKGROUND:Little is known how individual time-in-therapeutic-range (TTR) impacts the effectiveness and safety of warfarin therapy compared to direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF). OBJECTIVE:To compare the effectiveness and safety of standard dose DOACs to warfarin in patients with AF, while categorizing warfarin treated patients into quartiles based on their individual TTR. MATERIALS AND METHODS:We conducted a nationwide study including all patients with new-onset AF between 2011 and 2018 in Finland. Hazard ratios (HR) were calculated using Cox regression analysis with the inverse probability of treatment weighted method to assess the risks of ischaemic stroke (IS), intracranial haemorrhage (ICH) and mortality for users of apixaban (n = 12,426), dabigatran (n = 4545), rivaroxaban (n = 12,950) and warfarin (n = 43,548). RESULTS:The median TTR for warfarin users was 72%. Compared to the second best TTR quartile (reference), the risk of IS was higher in the two poorest TTR quartiles, and lower in the best TTR quartile and on rivaroxaban [2.35 (95% confidence interval, 1.85-2.85), 1.44 (1.18-1.75), 0.60 (0.47-0.77) and 0.72 (0.56-0.92)]. These differences were non-significant for apixaban and dabigatran. HR of ICH was 6.38 (4.88-8.35) and 1.87 (1.41-2.49) in the two poorest TTR groups, 1.44 (1.02-1.93) on rivaroxaban, and 0.58 (0.40-0.85) in the best TTR group compared to the reference group. Mortality was higher in the two poorest TTR groups and lowest in the best TTR group. CONCLUSIONS:The outcome was unsatisfactory in the two lowest TTR quartiles - in half of the patients treated with warfarin. The differences between the high TTR groups and standard dose DOACs were absent or modest.

AIM:A recent European Heart Rhythm Association (EHRA) practical guide provides guidance on the use of novel digital devices for heart rhythm analysis using either electrocardiogram (ECG) or photoplethysmography (PPG) technology for the diagnosis of atrial fibrillation (AF). This survey assesses physicians' preferences to use digital devices in patients with possible AF and their impact on clinical decision-making. METHODS AND RESULTS:Participants of the DAS-CAM III initiated and distributed an online survey assessing physician preferences in using digital devices for the management of AF in different clinical scenarios. A total of 505 physicians (median age: 38 [IQR 33-46] years) from 30 countries completed the survey. A third of respondents were electrophysiologists, the others were cardiologists, cardiology residents, or general practitioners. Electrophysiologists were more likely to have experience with both ECG-based (92% vs. 68%, p < 0.001) and PPG-based (60% vs. 34%, p < 0.001) digital devices. The initial diagnostic approach to each scenario (symptomatic low-risk, symptomatic high-risk, or asymptomatic high-risk patient) was heterogeneous. Electrophysiologists preferred intermittent single-lead ECG monitoring to traditional Holter ECGs to screen for AF. Both electrophysiologists and non-electrophysiologists would rarely use PPG-based devices to diagnose and screen for AF (8.2%-9.8%). Electrophysiologists and non-electrophysiologists use ECG-based technology to confirm PPG-documented tracings suggestive of AF. CONCLUSION:While PPG-based digital devices are rarely used for diagnosis and screening for AF, intermittent ECG-based digital devices are beginning to be implemented in clinical practice. More education on the potential of novel digital devices is required to achieve diagnostic pathways as suggested by the EHRA practical guide.

Background:Cardiac interventions may be challenging in patients with congenital cardiac abnormalities. This case reports cardiac resynchronization therapy pacemaker (CRT-P) implantation and single catheter ablation of atrioventricular node (AVN) with remote magnetic navigation (RMN) via peripheral vascular access in a patient with Kartagener's syndrome and permanent atrial fibrillation (AF). Case summary:A 74-year-old male with situs inversus presented for treatment of permanent AF and severe heart failure. In echocardiography, left ventricular ejection fraction was 30%, and there was severe dyskinesia due to a left bundle branch block. After successful CRT-P implantation, we performed AVN ablation because biventricular (BiV) pacing was <75% despite maximal rate control medication. The ablation catheter was inserted from the right basilic vein, and no other catheters were used. Despite peripheral vascular access, manipulation of the ablation catheter with RMN was easy, and the ablation was successful. After the ablation, BiV pacing instantly increased to 100%, and left ventricular function and symptomatic status improved gradually. Conclusions:Cardiac resynchronization therapy pacemaker implantation and RMN-guided single catheter ablation of the AVN in a patient with dextrocardia via peripheral vascular access was effective and safe. The use of RMN and peripheral vascular access may offer important advantages also in other patient groups.

Background Atrial fibrillation (AF) is a major risk factor for ischemic stroke (IS), but whether the magnitude of this risk has changed over time is unknown. Objectives This study sought to investigate temporal trends in IS rates in patients with incident AF before oral anticoagulant agent (OAC) therapy. Methods The nationwide FinACAF (Finnish Anticoagulation in Atrial Fibrillation) study covers patients with AF at all levels of care in Finland from 2007 to 2018. A 4-week quarantine period from AF diagnosis was applied, and only follow-up time without OAC therapy was included. Incidence rates of IS were computed in 4-year intervals in relation to sex and non-sex CHA2DS2-VASc (ie, CHA2DS2-VA) score values. Results In total, 129,789 patients with new-onset AF were identified (49.2% women; mean age: 71.4 ± 14.5 years). Between the calendar year intervals of 2007-2010 and 2015-2018, the patients’ mean CHA2DS2-VA score increased from 2.5 to 3.0, and concurrently the overall IS rate decreased by 25% from 36.7 to 27.6 events per 1,000 patient-years. This trend was driven by a 32% decrease of IS rate in women, particularly among those with higher age and CHA2DS2-VA scores. The IS rate in patients with a CHA2DS2-VA score of 1 was 8.2 events per 1,000 patient-years and remained stable across the study period. Conclusions The initial IS risk in AF patients, before the initiation of OAC therapy, has decreased by 25% between 2007 and 2018 despite an increase in both age and stroke risk scores. The decrease has been most pronounced in older women with high stroke risk scores.

Aims Atrial fibrillation (AF) patients frequently require active rhythm control therapy to maintain sinus rhythm and reduce symptom burden. Our study assessed whether antiarrhythmic therapies (AATs) are used disproportionately between men and women after new-onset AF. Methods and results The nationwide Finnish anticoagulation in AF registry-based linkage study covers all patients with new-onset AF in Finland during 2007-2018. Study outcomes included initiation of AATs in the form of antiarrhythmic drugs (AADs), cardioversion, or catheter ablation. The study population constituted of 229 565 patients (50% females). Women were older than men (76.6 +/- 11.8 vs. 68.9 +/- 13.4 years) and had higher prevalence of hypertension or hyperthyroidism, but lower prevalence of vascular disease, diabetes, renal disease, and cardiomyopathies than men. Overall, 17.6% of women and 25.1% of men were treated with any AAT. Women were treated with AADs more often than men in all age groups [adjusted subdistribution hazard ratio (aSHR) 1.223, 95% confidence interval (CI) 1.187-1.261]. Cardioversions were also performed less often on women than on men aged <65 years (aSHR 0.722, 95% CI 0.695-0.749), more often in patients >= 75 years (aSHR 1.166, 95% CI 1.108-1.227), while no difference between the sexes existed in patients aged 65-74 years. Ablations were performed less often in women aged <65 years (aSHR 0.908, 95% CI 0.826-0.998) and >= 75 years (aSHR 0.521, 95% CI 0.354-0.766), whereas there was no difference in patients aged 65-74 years. Conclusion Women used more AAD than men in all age groups but underwent fewer cardioversion and ablation procedures when aged <65 years.

Objectives Atrial fibrillation (AF) is associated with increased mortality. Previous studies have reported conflicting results in temporal trends of mortality after AF diagnosis. We aim to address this disparity by investigating the 1-year mortality and causes of death in Finnish patients diagnosed with AF between 2010 and 2017.Design The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study is a nationwide retrospective register-based cohort study.Setting The FinACAF study has gathered information on all Finnish AF patients between 2004 and 2018, with information from all national healthcare registers and data from all levels of care (primary, secondary and tertiary care).Participants We included patients with an incident AF diagnosis (International Classification of Diseases, 10th Revision code I48) between 2010 and 2017. To ensure a cohort of only incident AF, we excluded patients who used any oral anticoagulant during the year before cohort entry as well as patients with a recorded use of warfarin between 2004 and 2006. Patients under 20 years of age were excluded, and patients with permanent migration abroad before 1 January 2019 were excluded, N=157 658.Primary outcome measures 1-year all-cause, cardiovascular (CV) and cause-specific mortality following AF diagnosis.Results The study cohort consisted of 157 658 incident AF cases (50.1% male, mean age 72.9 years). Both all-cause and CV mortality declined from cohort entry years 2010–2017 (from 12.9% to 10.6%, mortality rate ratio (MRR) 0.77; 95% CI 0.73 to 0.82 in cohort entry year 2017 with 2010 as reference; and from 7.4% to 5.2%, MRR 0.68; 95% CI 0.63 to 0.74, respectively). Overall mortality and CV mortality were lower in women than in men throughout the study period (MRR 0.66; 95% CI 0.63 to 0.69 and MRR 0.53; 95% CI 0.50 to 0.56, respectively). Deaths attributable to ischaemic heart disease decreased during the study period (from 30.7% to 21.6%, MRR 0.51; 95% CI 0.49 to 0.62 in 2017 vs 2010), whereas dementia and Alzheimer’s disease increased as a cause of death over time (6.2% to 9.9%, MRR 1.19; 95% CI 0.96 to 1.48 in 2017 vs 2010). The CHA2DS2-VASc score associated strongly with 1-year survival (p<0.0001).Conclusions Our study reiterates that mortality after diagnosis of AF has decreased. The CHA2DS2-VASc score highlights the need to treat comorbidities as it strongly associates with patient 1-year survival after initial AF diagnosis.