Table1_Electronic health record-wide association study for atrial fibrillation in a British cohort.docx

BackgroundAtrial fibrillation (AF) confers a major healthcare burden from hospitalisations and AF-related complications, such as stroke and heart failure. We performed an electronic health records-wide association study to identify the most frequent reasons for healthcare utilization, pre and post new-onset AF.
MethodsProspective cohort study with the linked electronic health records of 5.6 million patients in the United Kingdom Clinical Practice Research Datalink (1998–2016). A cohort study with AF patients and their age-and sex matched controls was implemented to compare the top 100 reasons of frequent hospitalisation and primary consultation.
ResultsOf the 199,433 patients who developed AF, we found the most frequent healthcare interactions to be cardiac, cerebrovascular and peripheral-vascular conditions, both prior to AF diagnosis (41/100 conditions in secondary care, such as cerebral infarction and valve diseases; and 33/100 conditions in primary care), and subsequently (47/100 conditions hospital care and 48 conditions in primary care). There was a high representation of repeated visits for cancer and infection affecting multiple organ systems. We identified 10 novel conditions which have not yet been associated with AF: folic acid deficiency, pancytopenia, idiopathic thrombocytopenic purpura, seborrheic dermatitis, lymphoedema, angioedema, laryngopharyngeal reflux, rib fracture, haemorrhagic gastritis, inflammatory polyneuropathies.
ConclusionOur nationwide data provide knowledge and better understanding of the clinical needs of AF patients suggesting: (i) groups at higher risk of AF, where screening may be more cost-effective, and (ii) potential complications developing following new-onset AF that can be prevented through implementation of comprehensive integrated care management and more personalised, tailored treatment.
Clinical trial registrationNCT04786366

背景
心房颤动（Atrial Fibrillation, AF）可因住院治疗及房颤相关并发症（如脑卒中、心力衰竭）带来沉重的医疗负担。本研究开展电子健康档案全范围关联研究，旨在明确新发房颤前后最常见的医疗服务利用原因。

方法
本研究为前瞻性队列研究，使用英国临床实践研究数据链（Clinical Practice Research Datalink，1998–2016）中560万患者的关联电子健康档案数据。研究纳入房颤患者及其年龄、性别匹配的对照人群，开展队列分析以对比最常见的前100项住院及基层诊疗原因。

结果
在199433例新发房颤患者中，我们发现无论房颤确诊前还是确诊后，最常见的医疗服务接触均为心脏、脑血管及外周血管疾病：房颤确诊前，二级医疗机构中占比41/100的疾病为脑梗死、瓣膜病等，基层医疗机构中占比33/100的疾病与此类相关；确诊后，住院医疗中占比47/100的疾病及基层医疗机构中占比48/100的疾病亦为此类。此外，累及多器官系统的癌症与感染相关的反复就诊占比颇高。本研究还识别出10种此前未被报道与房颤相关的新型疾病：叶酸缺乏症、全血细胞减少症、特发性血小板减少性紫癜、脂溢性皮炎、淋巴水肿、血管性水肿、喉咽反流、肋骨骨折、出血性胃炎及炎症性多发性神经病。

结论
本研究基于全国性数据集，加深了我们对房颤患者临床需求的认知与理解，提示：（1）可识别房颤高危人群，针对此类人群开展筛查或将具备更高的成本效益；（2）新发房颤后可能出现的潜在并发症可通过实施全面整合的照护管理及更具个性化的定制化治疗加以预防。

临床试验注册：NCT04786366