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Birth cohort effect in atrial fibrillation: a matter of detection?
  1. Michelle Samuel1,2,3,
  2. Michiel Rienstra1
  1. 1Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  2. 2Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  3. 3Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  1. Correspondence to Michelle Samuel, Cardiology and Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; m.samuel{at}

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Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, affecting an estimated 43 million people globally.1 In the last 20 years, the incidence of AF increased by 33% and it is expected to increase by threefold in the next three decades.1 Long-term AF management, including outpatient visits, hospitalisations and disabilities from stroke and heart failure (HF), adds substantial burden on healthcare resources and costs, accounting for 2.6% of the total annual healthcare expenditure of European countries.2 As a result, AF has emerged as a major public health concern and a potential future epidemic.1

The increasing temporal trend in AF diagnoses has been attributed to older populations, more survivors of cardiovascular diseases and a higher prevalence of AF risk factors; however, these determinants are interconnected. Age plays a key role in the aetiology of most diseases, including AF and the traditional risk factors of hypertension, diabetes, HF and coronary artery disease.3 Although temporal trends provide valuable insight regarding the evolution in the incidence of diseases over time, the underlying cause for the trend is unknown.4 A key limitation is that time trends in epidemiological data are strongly related to age and decoupling the effect of age with other time trends may be overlooked.4

Vinter and colleagues investigated the interaction between age, period and cohort effects to determine the impact of birth year on the diagnosis of AF.5 Danish National Registries (1980–2018) were used to evaluate trends in the age-stratified 10-year cumulative incidence of AF among persons ≥45 years (n=4 783 940).5 Included patients were stratified in 5-year intervals …

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  • Contributors All authors contributed to the manuscript equally.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MS receives honoraria from the American College of Cardiology Foundation. MR reports research grants from ZonMW and Dutch Heart Foundation (DECISION project 848090001); Netherlands Cardiovascular Research Initiative (RACE V CVON 2014–9, RED-CVD CVON2017-11); Top Sector Life Sciences & Health to the Dutch Heart Foundation (PPP Allowance; CVON-AI 2018B017) and European Union’s Horizon 2020 (EHRA-PATHS 945260) and consultancy fees from Bayer and InCarda Therapeutics.

  • Provenance and peer review Commissioned; internally peer reviewed.

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