Original Article
Click here to view the Editorial Comment by G.Y.H. Lip
Atrial fibrillation prevalence revisited
L. Friberg1,2 & L. Bergfeldt3
From the 1Department of Clinical Science, Karolinska Institute, Danderyd Hospital, Stockholm; 2Department of Cardiology, Danderyd
Hospital, Stockholm; and 3Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburgh,
Gothenburg, Sweden
Abstract. Friberg L, Bergfeldt L (Karolinska Institute,
Danderyd Hospital, Stockholm; Sahlgrenska
Academy, University of Gothenburgh, Gothenburg,
Sweden.). Atrial fibrillation prevalence revisited. J
Intern Med 2013; 274: 461–468.
Background. The estimate of 0.4–1.0% prevalence of
atrial fibrillation in the most recent American guide-
lines is based mainly on studies including patients
with permanent atrial fibrillation (AF), although
recent evidence shows that the stroke risk is similar
with paroxysmal and persistent AF. Our objective
was to determine the prevalence of AF in Sweden,
irrespective of type and to what extent patients with
AF receive adequate stroke prophylaxis.
Method. Retrospective study of patients with a clin-
ical diagnosis of atrial fibrillation between 2005
and 2010 in the national Swedish Patient Register
matched with data from the National Prescribed
Drugs Register.
Results. We identified 307 476 individuals with a
diagnosis of atrial fibrillation. Of these, 209 141
Introduction
Atrial fibrillation (AF) is associated with a 4–5-fold
increased risk of stroke [1, 2], a 2–3-fold increased
risk of cardiac failure [3], almost a doubling of
mortality [4, 5] and impaired quality of life [6]. It is
generally recognized as the most common signifi-
cant dysrhythmia, although the prevalence esti-
mates are highly diverging. The latest version of the
American guideline document on AF says, ‘The
estimated prevalence of AF is 0.4% to 1.0% in the
general population’ [7] whilst their European coun-
terpart estimates the prevalence to be ‘1.5–2.0% of
the general population’ [8]. This variability and
uncertainty about the prevalence is in part due to
inclusion of different types of AF. Older studies
mostly counted patients with permanent AF, which
only constitute a minority of all patients with AF
[9]. For many years, the general belief was that
paroxysmal AF is less hazardous than permanent
ª 2013 The Association for the Publication of the Journal of Internal Medicine
doi: 10.1111/joim.12114
were still alive on the last day of the inclusion
period, signifying a prevalence of clinically diag-
nosed AF in Sweden of 2.9% of the total adult
(≥20 years) population. Only 42% of them had
purchased an oral anticoagulant within 6 months
of the first presentation with AF during the study
period. Those at the highest risk of stroke were
those least likely to receive anticoagulant treat-
ment. Undertreatment was common amongst
women and individuals >80 years, whilst over-
treatment was common amongst young men with-
out risk factors.
Conclusion. The prevalence of atrial fibrillation is at
least 2.9% of the Swedish adult population, not
counting ‘silent atrial fibrillation’. The official US
figures probably underestimate the magnitude of
the problem by a factor of 3–5. More than 80%
had risk factors motivating anticoagulation ther-
apy.
Keywords: anticoagulation, atrial fibrillation, epide-
miology.
AF. However, it has been shown that stroke rates
are similar in both forms [10–12]. Thus, there is
lack of information about the clinically relevant AF
prevalence, which is needed for the assessment of
its impact on, for example, stroke and heart failure
and for planning of future health care.
The aim of this study was to determine the preva-
lence of clinically diagnosed AF in adults in Sweden,
irrespective of type (paroxysmal, persistent or per-
manent) and to determine to what extent patients
with AF are receiving adequate stroke prophylaxis.
Methods
Study population
We included all adults (≥20 years) with a primary or
secondary diagnosis of AF between 1 July 2005 and
31 December 2010, listed in the national Swedish
Patient Register. It covers all hospitals in the coun-
461
 L. Friberg & L. Bergfeldt
try since 1987 and provides complete lists of dates
of admissions and discharges with diagnostic codes
according to the 10th revision of the International
Classification of Diseases (ICD-10), as well as codes
for surgical and therapeutic procedures. The
Patient Register also includes information about
out-patient visits at hospitals and hospital-man-
aged satellite centres, but not about visits in the
primary care (general practitioners offices).
We used the ICD-10 code I489 to identify individuals
with an AF diagnosis. This definition includes both
atrial fibrillation and flutter because these dys-
rhythmias are closely related and also have a similar
stroke risk [13]. Each individual was only counted
once and there were no exclusion criteria. The date
of the first occasion with an AF diagnosis during the
inclusion period was used as index date. Diagnoses
given prior to index date were used for the charac-
terization of previous and concurrent diseases.
We used this background information to calculate
each patient’s stroke risk score according to the
CHADS2 scheme, which gives 2 points for a previ-
ous stroke, TIA or systemic emboli, and one point
each for heart failure, hypertension, diabetes and
age ≥75 years [14]. We also calculated the newer
CHA2DS2-VASc score, which in addition to the
CHADS2 score gives 2 points for age ≥75, and 1
point each for age 65-74 years, vascular disease
and female sex [1, 15]. The codes used to define
these conditions are listed in Appendix S1.
Bleeding risk was calculated using a modified HAS-
BLED score (16) counting points for hypertension,
renal failure, liver disease, thromboembolism, pre-
vious bleeding, age ≥65 years, prescription of ASA
or clopidogrel and alcohol abuse defined from a
diagnostic code belonging to the ‘alcohol index’
used for statistical purposes by the National Board
of Health and Welfare (see Appendix S1). We had no
information about INR values for patients treated
with warfarin and had omit giving points for that.
Dates of deaths were obtained from the Swedish
Population Register. Information about the general
population was obtained from the government
agency Statistics Sweden. To make our results
comparable with other studies in the field, we
expressed prevalence as that in the adult popula-
tion aged ≥20 years, which on 31 December 2010
was 7 232 006.
Information about medication was obtained from
the National Prescribed Drugs Register. This
462 ª 2013 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine, 2013, 274; 461–468
Atrial fibrillation prevalence revisited
register automatically stores detailed information
about every prescription that is handled in every
pharmacy in the country since 1 July 2005 and is
therefore almost 100% complete. Medication at
baseline was defined as drugs that had been
collected at a pharmacy within 90 days of the
index date. The only registered oral anticoagulant
in Sweden during the study period was warfarin,
with phenprocoumon as an alternative on special
licence for a very small number of patients intol-
erant to warfarin.
Statistical methods
Baseline characteristics were presented descrip-
tively, and differences were tested with t-tests and
chi-squared test. P-values <0.05 were considered
significant. All analyses were performed in SPSS
20.0 (IBM SPSS Statistics, IBM Corporation, Route
100, Somers, NY 10589, USA).
Ethical approval
Approval for the study was obtained from the
regional ethical committee in Stockholm (EPN
2005/22–21/4, 2008/433–32).
Results
Prevalence
During the 5.5-year inclusion period, 307 476
unique adult individuals received a hospital diag-
nosis of AF in Sweden; 98 335 of them died before
the end of that period. Thus, on 31 December
2010, there were 209 141 living men and women
with a diagnosis of AF corresponding to a
prevalence of 2.9% of the adult Swedish popula-
tion. The mean age was 75.2  12.2 years at the
index date (men 71.9  12.3 years, women
82.2  8.5 years). Clinical characteristics of those
who survived, and of those who died before the
end of the inclusion period, are presented in
Table 1. The prevalence increased with age up to
14.3% (6168/43 237) at 84 years where after the
proportion of individuals with AF appeared to
decrease (Fig. 1). The prevalence was higher in
men than in women in all age groups (Table 2) and
higher in rural areas where the mean age of the
population is higher. Thus, prevalence ranged
from 2.5% in the Swedish capital Stockholm,
where the mean age of the population is
39.0 years, up to 3.5% in the northernmost rural
region of Norrbotten, where mean age of the
population was 42.4 years.
 L. Friberg & L. Bergfeldt Atrial fibrillation prevalence revisited

Table 1 Clinical and demographic characteristics

All patients Survived Died

(n = 307 476) (n = 209 141) (n = 98 335)
Age at index date, years
Mean  SD 75.2  12
2 71.9  12
3 82.2  8
5
Median 77 74 84
<65 18% 25% 4%
65–74 23% 28% 12%
≥75 59% 47% 84%
Sex
Women 45% 43% 49%
Men 55% 57% 51%
Risk score
CHADS2 1.9  1.4 1.6  1.4 2.6  1.4
CHA2DS2-VASc 3.4  1.9 3.0  1.8 4.4  1.7
HAS-BLEDa 2.1  1.1 1.9  1.1 2.4  1.1
Medical history
Thromboembolism 21% 16% 30%
Heart failure 31% 22% 49%
Hypertension 45% 45% 46%
Diabetes 17% 14% 21%
Vascular disease 23% 19% 33%
Prophylaxis at index date
Warfarin only 30% 34% 20%
ASA only 34% 29% 45%
Clopidogrel only 1% 1% 1%
Warfarin 12% 15% 7%
combos
ASA+Clopidogrel 3% 3% 3%
None 20% 19% 24%

a
Modified HAS-BLED without variable ‘labile INR’.

risk stratification schemes, hypertension was the

Comorbidities
Over the years, the patients had accumulated a
mean of 50.2 diagnoses prior to the index date. In
most patients, a few diagnoses reappeared several
times in conjunction with new healthcare contacts.
At the index date, >80% of the patients had
comorbidities which would warrant consideration
for stroke prophylaxis according to current Amer-
ican and European guideline recommendations
(CHADS2 score ≥2 in 82% of patients, CHA2DS2-
VASc score ≥2 in 83%) [7, 8]. About one-third
(34.7%) had high bleeding risk defined as HAS-
BLED score ≥3. Amongst the comorbidities in the
most common affecting 45%, followed by heart
failure which was found in 31% (Table 3).
Stroke prophylaxis
Warfarin, alone or in combination with ASA or
clopidogrel, was used by 42% of the patients. ASA
as single therapy was used by 34% and 20% of the
patients had no therapy at all (Table 1). Warfarin
use was inversely associated with stroke risk so
that those at the highest risk of stroke were the
least likely to receive it (Fig. 2). In contrast, ASA
use increased in parallel with increasing stroke
risk score (Fig. 3). After 80 years of age, warfarin

ª 2013 The Association for the Publication of the Journal of Internal Medicine 463
Journal of Internal Medicine, 2013, 274; 461–468
 L. Friberg & L. Bergfeldt Atrial fibrillation prevalence revisited

Fig. 1 Prevalence of diag-

nosed atrial fibrillation in rela-
tion to age on 31 December
2010.

Table 2 Atrial fibrillation prevalence by age and sex amongst 209 141 patients alive on 31 December 2010

P
All (n = 209 141) % Men (n = 118 919) % Women (n = 90 222) % Men vs. women
<60 years (n = 30 277) 0.6 0.9 0.3 <0.0001
60–69 years (n = 48 844) 4.2 5.7 2.7 <0.0001
70–79 years (n = 67 089) 9.7 11.5 8.1 <0.0001
80–89 years (n = 55 232) 13.4 14.8 12.6 <0.0001
≥90 years (n = 7699) 9.0 10.1 8.5 <0.0001
All ages 2.9 3.3 2.5 <0.0001

Table 3 Comorbidities in relation to age amongst all 307 476 patients with AF diagnosis

Thromboembolism Heart failure Diabetes Hypertension Vasc. disease

Age, years (n = 63 118) % (n = 95 021) % (n = 51 223) % (n = 138 858) % (n = 71 244) %
<60 (n = 31 952) 5.4 12.3 8.9 24.8 8.5
60–69 (n = 55 508) 12.5 19.1 17.0 43.3 17.7
70–79 (n = 88 886) 20.2 28.2 19.5 49.4 24.4
80–89 (n = 106 182) 27.6 40.4 17.4 49.1 28.4
≥90 (n = 24 948) 28.8 50.1 12.6 43.3 27.3
All ages 20.5 30.9 16.6 45.1 23.1

AF, atrial fibrillation.

use dropped rapidly, and at 90 and higher less

than 10% received warfarin (Table 4, Fig. 4). Men
were treated with warfarin more often than women
(46% vs. 37%, P < 0.0001). Warfarin use was
relatively common amongst young men with no
risk points. In the very low-risk group with 0 points
on CHA2DS2-VASc, 38% had warfarin. Cardiover-
sion was not the primary reason for treatment in
this group because only 11% of them (2347/
20 899) were cardioverted during the study period.
Discussion
The present prevalence estimate of at least 2.9% is
considerably higher than the current official esti-
mate of 0.4–1.0% in the 2011 guideline update
from the American College of Cardiology/American
Heart Association/Heart Rhythm Society [7]. The
American guidelines refer to two sources. One is a
meta-analysis from 1995 [18] where the authors
admit that there were so few elderly patients in the

464 ª 2013 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine, 2013, 274; 461–468
 L. Friberg & L. Bergfeldt
Fig. 2 Warfarin use amongst men and women in relation
to CHA2DS2-VASc and HAS-BLED score.
Fig. 3 ASA use amongst men and women in relation to
CHA2DS2-VASc and HAS-BLED score.
studies that the they had to ‘arbitrarily chose a
prevalence rate of 10% for all persons older than
80 years’, which is obviously too low. The lack of
Atrial fibrillation prevalence revisited
data on elderly patients was due to upper age limits
for inclusions in the studies. The second reference
is the ATRIA study, which only counted patients
‘with nontransient atrial fibrillation’, that is, per-
manent AF, which also had to be the principal
diagnosis [17]. In the Euro Heart Survey [9] only
30% of the patients had permanent AF and would
have fulfilled the ATRIA criteria. Furthermore, the
criterion that AF had to be the principal diagnosis
presumably resulted in the exclusion of patients
with many comorbidities who are likely to receive
some other more urgent diagnosis at discharge,
rather than AF. Thus, many patients with AF were
not counted in these earlier prevalence studies
performed at a time when nonpermanent AF was
believed to carry a low risk for stroke.
Observations on stroke prophylaxis
Only 42% of the patients had purchased warfarin at
least once during a 6-month period framing the
index date, although 83% of them had a risk score
indicating that they would have benefited from
anticoagulation therapy, unless there were strong
reasons against it [19, 20]. Paradoxically, those at
the highest risk of stroke were those least likely to
receive warfarin treatment. There was an almost
linear decrease in the likelihood of receiving warfa-
rin with increasing stroke risk. In contrast, the
likelihood for receiving ASA increased almost line-
arly with increasing risk. One way to interpret this is
that prescribing doctors recognize the high stroke
risk in patients with high-risk scores, but that they
consider them too frail for anticoagulants and chose
ASA instead. ASA is often perceived as a ‘milder’
treatment option, although the protective effect is
very weak and the bleeding risk is about the same as
with well-managed warfarin therapy [8, 21].
Warfarin treatment rapidly declined after the age of
80, although it is well recognized that advanced age
is one of the most important stroke risk factors.
Women were less often treated with warfarin than
men at all ages (37% vs. 46%), despite their higher
stroke risk [22, 23]. The reason for this is unclear
and calls for further investigation and measures to
improve current practices.
Generalizability of the results
The prevalence of AF within a population is clearly
related to the proportion of elderly individuals. In
our study, we found that the regional prevalence
varied between 2.5% and 3.5% between two
ª 2013 The Association for the Publication of the Journal of Internal Medicine 465
Journal of Internal Medicine, 2013, 274; 461–468
 L. Friberg & L. Bergfeldt Atrial fibrillation prevalence revisited

Table 4 Warfarin use at the index date amongst all 307 476 patients with AF diagnosis

P
All (n = 307 476) % Men (n = 168 630) % Women (n = 138 846) % Men vs. women
<60 (n = 31 952) 39.0 41.7 30.9 <0.0001
60–69 (n = 55 508) 52.9 55.8 46.6 <0.0001
70–79 (n = 88 886) 53.8 55.8 51.2 <0.0001
80–89 (n = 106 182) 35.2 37.6 33.2 <0.0001
≥90 (n = 24 948) 9.7 11.2 8.9 <0.0001
All ages 42.1 46.4 36.8 <0.0001

AF, atrial fibrillation.

Fig. 4 Warfarin use in relation

to age and sex amongst all
307 476 patients with atrial
fibrillation (AF).

regions where the mean ages of the populations
only differed by 3.4 years. In countries with youn-
ger population structures than the Swedish, the
overall AF prevalence will probably be lower, but
age and sex stratified prevalence may still be
similar. Considering that many countries have
rapidly ageing populations the information about
the age and sex stratified prevalence is relevant for
the dimensioning of the future healthcare system,
especially with regard to the association with
stroke and heart failure, which are the major cost
drivers [24].
It has been suggested that AF prevalence may vary
according to the ethnic background, which is not
registered for Swedish residents, unlike in the
United States and many other countries. Although
Sweden has become more multicultural in recent
decades, the Swedish population still consists
mainly of Caucasians. According to the official
statistical agency Statistics, Sweden only 14% of
the inhabitants were born abroad, and of these, the
majority were born in Europe [25]. The results of
our study may therefore not be directly applicable
to a country with a predominantly non-Caucasian
population.
Limitations
It has not been possible for us to verify the AF
diagnoses by ECG recordings. However, a recent
validation study of the Swedish Patient Register
could confirm AF in 97% of a random sample [26].
The extent of under diagnosis is not known and
would require population screening to be deter-
mined. However, in the greater Gothenburg area
(Vaestra Goetaland County) of 1.2 million adults,
22% of the patients with AF were cared for only in
primary care (Staffan Bj€
orck, personal communi-
cation), which extrapolated to the whole country
suggests a prevalence of 3.5%. Patients with sev-
eral more urgent or serious diagnoses may have
been left without an AF diagnosis at discharge.
Underreporting of concomitant and previous dis-
eases may have occurred for similar reasons. This
may have affected the risk scores for ischaemic
stroke, CHADS2 and CHA2DS2-VASc, giving

466 ª 2013 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine, 2013, 274; 461–468
 L. Friberg & L. Bergfeldt
patients falsely lower risk scores than they actually
should have had.
Conclusion
The prevalence of AF is at least 2.9% of the Swedish
adult population. The current US guidelines prob-
ably underestimate the magnitude of the problem
by a factor 3–5 and therefore also the fraction of
individuals at risk of AF-related stroke, who might
benefit from prophylactic therapy with oral antico-
agulants.
Conflict of interest statement
Both authors have completed the ICMJE uniform
disclosure form at www.icmje.org/coi_disclosure.
pdf (available on request from the corresponding
author) and declare: the submitted work was
supported by The Swedish Heart and Lung Foun-
dation and The Stockholm County Council; no
financial relationships with any organisations that
might have an interest in the submitted work in the
previous 3 years; Outside of the submitted work,
Karolinska Institute received grants in support of
LF’s research from Boehringer-Ingelheim, Sanofi-
Aventis, Bristol-Myers-Squibb and Bayer. LF has
participated in advisory boards with Boehringer-
Ingelheim and Sanofi-Aventis. LB has participated
in advisory boards with Sanofi-Aventis, Boehrin-
ger-Ingelheim and MSD, and given lectures sup-
ported by Sanofi-Aventis and MSD.
Authorship
Both authors participated in the drafting of the
study and in revisions of the manuscript. LF
prepared the data file, made the statistical analy-
ses and wrote the first manuscript draft. LF takes
full responsibility for the accuracy of the statistical
analyses.
Funding
The Swedish Heart and Lung Foundation, and the
Stockholm County Council. The manuscript con-
forms to the STROBE statement for cross-sectional
studies.
References
1 Flegel KM, Shipley MJ, Rose G. Risk of stroke in non-rheu-
matic atrial fibrillation. Lancet 1987; 1: 526–9.
Atrial fibrillation prevalence revisited
2 Wolf PA, Dawber TR, Thomas HE Jr, Kannel WB.
Epidemiologic assessment of chronic atrial fibrillation and
risk of stroke: the Framingham study. Neurology 1978; 28:
973–7.
3 Stewart S, Hart CL, Hole DJ, McMurray JJ. A popula-
tion-based study of the long-term risks associated with atrial
fibrillation: 20-year follow-up of the Renfrew/Paisley study.
Am J Med 2002; 113: 359–64.
4 Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H,
Kannel WB, Levy D. Impact of atrial fibrillation on the risk
of death: the Framingham Heart Study. Circulation 1998;
98: 946–52.
5 Friberg L, Hammar N, Pettersson H, Rosenqvist M. Increased
mortality in paroxysmal atrial fibrillation: report from the
Stockholm Cohort-Study of Atrial Fibrillation (SCAF). Eur
Heart J 2007; 28: 2346–53.
6 Thrall G, Lane D, Carroll D, Lip GY. Quality of life in patients
with atrial fibrillation: a systematic review. Am J Med 2006;
119: 448.e1–19.
7 Fuster V, Ryden LE, Cannom DS et al. 2011 ACCF/AHA/HRS
focused updates incorporated into the ACC/AHA/ESC 2006
guidelines for the management of patients with atrial fibril-
lation: a report of the American College of Cardiology Foun-
dation/American Heart Association Task Force on practice
guidelines. Circulation 2011; 123: e269–367.
8 Camm AJ, Lip GY, De Caterina R et al. 2012 focused update
of the ESC Guidelines for the management of atrial fibrilla-
tion: an update of the 2010 ESC Guidelines for the manage-
ment of atrial fibrillation Developed with the special
contribution of the European Heart Rhythm Association.
Europace 2012; 14: 1385–413.
9 Nieuwlaat R, Capucci A, Camm AJ et al. Atrial fibrillation
management: a prospective survey in ESC member countries:
the Euro Heart Survey on Atrial Fibrillation. Eur Heart J
2005; 26: 2422–34.
10 Hart RG, Pearce LA, Rothbart RM, McAnulty JH, Asinger RW,
Halperin JL. Stroke with intermittent atrial fibrillation: inci-
dence and predictors during aspirin therapy. Stroke preven-
tion in atrial fibrillation investigators. J Am Coll Cardiol 2000;
35: 183–7.
11 Hohnloser S, Pajitnev D, Pogue J et al. Incidence of stroke in
paroxysmal versus sustained atrial fibrillation in patients
taking oral anticoagulation or combined antiplatelet therapy
An ACTIVE W substudy. J Am Coll Cardiol 2007; 50:
2156–61.
12 Friberg L, Hammar N, Rosenqvist M. Stroke in paroxysmal
atrial fibrillation: report from the Stockholm Cohort of Atrial
Fibrillation. Eur Heart J 2010; 31: 967–75.
13 Ludvigsson JF, Andersson E, Ekbom A et al. External review
and validation of the Swedish national inpatient register.
BMC Public Health 2011; 11: 450.
14 Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW,
Radford MJ. Validation of clinical classification schemes for
predicting stroke: results from the National Registry of Atrial
Fibrillation. JAMA 2001; 285: 2864–70.
15 Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining
clinical risk stratification for predicting stroke and thrombo-
embolism in atrial fibrillation using a novel risk factor-based
approach: the euro heart survey on atrial fibrillation. Chest
2010; 137: 263–7.
16 Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip
GY. A novel user-friendly score (HAS-BLED) to assess 1-year
ª 2013 The Association for the Publication of the Journal of Internal Medicine 467
Journal of Internal Medicine, 2013, 274; 461–468
 L. Friberg & L. Bergfeldt
risk of major bleeding in patients with atrial fibrillation: the
Euro Heart Survey. Chest 2010 Nov; 138: 1093–100.
17 Go AS, Hylek EM, Phillips KA et al. Prevalence of diagnosed
atrial fibrillation in adults: national implications for rhythm
management and stroke prevention: the AnTicoagulation and
Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001;
285: 2370–5.
18 Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart
RG. Prevalence, age distribution, and gender of patients with
atrial fibrillation. Analysis and implications. Arch Intern Med
1995; 155: 469–73.
19 Singer DE, Chang Y, Fang MC et al. The net clinical benefit of
warfarin anticoagulation in atrial fibrillation. Ann Intern Med
2009; 151: 297–305.
20 Friberg L, Rosenqvist M, Lip GY. Net clinical benefit of
warfarin in patients with atrial fibrillation: a report from the
Swedish atrial fibrillation cohort study. Circulation 2012;
125: 2298–307.
21 Olesen JB, Lip GY, Lindhardsen J et al. Risks of thrombo-
embolism and bleeding with thromboprophylaxis in patients
with atrial fibrillation: a net clinical benefit analysis using a
‘real world’ nationwide cohort study. Thromb Haemost 2011;
106: 739–49.
22 Hughes M, Lip GY. Stroke and thromboembolism in atrial
fibrillation: a systematic review of stroke risk factors, risk
stratification schema and cost effectiveness data. Thromb
Haemost 2008; 99: 295–304.
468 ª 2013 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine, 2013, 274; 461–468
Atrial fibrillation prevalence revisited
23 Friberg L, Benson L, Rosenqvist M, Lip GY. Assessment of
female sex as a risk factor in atrial fibrillation in Sweden:
nationwide retrospective cohort study. BMJ 2012; 344:
e3522.
24 Ericson L, Bergfeldt L, Bjorholt I. Atrial fibrillation: the cost of
illness in Sweden. Eur J Health Econ 2011; 12: 479–87.
25 StatisticsSweden. Description of the population 2008
(Beskrivning av Sveriges befolkning 2008), 2009. http://
www.scb.se.
26 Smith JG, Platonov PG, Hedblad B, Engstrom G, Melander O.
Atrial fibrillation in the Malmo Diet and Cancer study: a study
of occurrence, risk factors and diagnostic validity. Eur J
Epidemiol 2010; 25: 95–102.
Correspondence: Leif Friberg, MD, PhD, Storskogsv€
agen 5,
SE-16765 Stockholm, Sweden.
(fax: +46701730519; e-mail: leif.friberg@ki.se).
Supporting Information
Additional Supporting Information may be found in
the online version of this article:
Appendix S1. Definition of diagnoses by ICD-10
codes and Swedish surgical procedural codes.