The optimal lookback period for estimating incidence and temporal trends in atrial fibrillation

Abstract

BACKGROUND Accurate measurement of atrial fibrillation (AF) incidence using secondary data is challenging because ofvari-ation in lookback period definitions used to distinguish incident from prevalent cases. As the choice of lookback period critically influences incidence estimates, establishing an appropriate duration is essential for sustained surveillance of AF trends. OBJECTIVE This study aimed to identify a reproducible definition of the lookback period and analyze trends in the incidence rate and prevalence of AF in Korea. METHODS This nationwide observational cohort study used Korean claims data from 2011 to 2021. Patients aged >= 20 years diagnosed with AF were identified. Annual age-and sex-standardized incidence rates were analyzed and compared across various lookback periods, and annual AF prevalence was calculated. RESULTS Among 1,185,366 patients with AF, the standardized incidence rate of AF was 2.14 per 1000 person-years in 2021 using a 10-year lookback period. A lookback period of at least 4 years yielded incidence rates within a 10% margin of those from a 10-year lookback period. Incidence rates varied depending on the duration of data availability and lookback periods, but using a fixed 4-year lookback produced consistent and stable estimates, ranging from 2.24 per 1000 person-years in 2015 to 2.32 in 2021. AF prevalence increased from 1.17% to 1.92% during the same period. CONCLUSION This study emphasizes the importance of defining and justifying lookback periods when estimating AF incidence. Using a fixed 4-year lookback period, we ensured a consistent and reproducible estimation of AF incidence and observed a steady increase in prevalence.