71 TRENDS IN PREVALENCE AND ANTITHROMBOTIC PRESCRIPTIONS IN AF CI 1.04–4.28 for patients with dementia compared with patients without dementia). Regarding age, for every year increase in age, the relative proportion of prevalent VKA prescriptions versus prevalent NOAC prescriptions seemed to increase with a factor 1.03 (95% CI 1.02–1.04). DISCUSSION This study was conducted in the general population to investigate trends in AF prevalence and antithrombotic treatment prescriptions from 2008 through 2017. Comparison with literature The prevalence of reported AF more than tripled in our study (from 0.4% in 2008 to 1.4% in 2017). Krijthe et al. estimated that the prevalence will more than double from 2010 to 2060.17 Interestingly, our study indicates that, at least in the Netherlands, the steep increase in AF prevalence occurs in a much shorter time period (i.e. tripling in a decade instead of doubling in half a century). Although the purpose of our study was not to explain the observed trends, this steeper than expected increase in reported AF prevalence deserves some consideration. Firstly, several factors may have contributed to the steep increase in reported AF prevalence: 1) increased awareness of AF related to the introduction of NOACs and the updated Dutch and European AF guidelines, 2) recent developments in Dutch primary care, which include disease managing programmes for patients with increased cardiovascular risk, and 3) enhanced digitalisation, resulting in improved accurateness and completeness of (AF) registration in electronic healthcare records. Secondly, in developed countries, a plausible reason for the steep increase in reported AF prevalence is a better survival after a first cardiovascular event, due to improved healthcare and an overall improvement in cardiovascular risk factor predisposition. This improved survival could expose patients to the spectrum of later-onset chronic cardiovascular disease, such as AF. This hypothesis is strengthened by studies in which a clear reduction in total cardiovascular morbidity and mortality over the last decades and a shift in the burden of cardiovascular morbidity from acute to chronic cardiovascular diseases, including the development of AF, were observed.18,19 In our study, 25.4% of all AF patients with a CHA2DS2-VASc score ≥2 were not prescribed OAC therapy (8.5% were prescribed platelet inhibitor monotherapy and 16.9% were not prescribed any antithrombotic therapy) in 2017. This is comparable to the results of the international GLORIA-AF registry (study period 2011–2014): 16.7% of new-onset AF patients with a CHA2DS2-VASc score ≥2 did not receive OAC therapy (10.0% were prescribed a platelet inhibitor and 6.7% were not prescribed any antithrombotic therapy).20 5
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