COVID-19 Pandemic and Trends in New Diagnosis of Atrial Fibrillation: A Nationwide Analysis of Claims Data

Inmaculada Hernandez, Meiqi He, Jingchuan Guo, Mina Tadrous, Nico Gabriel, Gretchen Swabe, Walid F. Gellad, Utibe R. Essien, Samir Saba, Emelia J. Benjamin, Jared W. Magnani

Atrial fibrillation (AF) is associated with a five-fold increased risk of stroke and a two-fold increased risk of death. We aimed to quantify changes in new diagnoses of AF following the onset of the COVID-19 pandemic. Investigating changes in new diagnoses of AF is of relevance because delayed diagnosis interferes with timely treatment to prevent stroke, heart failure, and death.

Disruptions in access to care associated with the COVID-19 pandemic represent potentially important health impacts of the pandemic beyond COVID cases and deaths. An emerging body of literature has reported decreases in the number of patients seeking emergency care in the earlier months of the COVID-19 pandemic. Significant reductions also have been observed in outpatient care for patients with chronic disease, even after accounting for the increased uptake of telemedicine.


Data source and study population

We obtained 1/1/2016-9/30/2020 de-identified data from Optum’s Clinformatics® Data Mart, which is derived from a database of administrative health claims for members of large commercial and Medicare Advantage health plans.


The primary outcome was new AF diagnosis, which was defined as having an inpatient or outpatient claim with International Classification of Diseases Ninth Revision (ICD-9) code 427.31 or International Classification of Diseases Tenth Revision (ICD-10) codes I48.0, I48.1, I48.2, or I48.91 in the first or second diagnosis field

In a large nationwide study, we observed that new AF diagnoses decreased immediately after the declaration of the COVID-19 pandemic; however, they returned to predicted levels by summer 2020. This decrease was consistent across racial and ethnic subgroups and states. The decrease in the rate of new AF diagnoses was larger for diagnoses originating from the outpatient setting than AF diagnoses originating from the inpatient setting.

Citation: Hernandez I, He M, Guo J, Tadrous M, Gabriel N, Swabe G, et al. (2023) COVID-19 pandemic and trends in new diagnosis of atrial fibrillation: A nationwide analysis of claims data. PLoS ONE 18(2): e0281068. https://doi.org/10.1371/journal.pone.0281068

Editor: Han Eol Jeong, Sungkyunkwan University, REPUBLIC OF KOREA

Received: October 20, 2022; Accepted: January 15, 2023; Published: February 2, 2023.

Copyright: © 2023 Hernandez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Optum’s Clinformatics® Data Mart (CDM) is derived from a database of administrative health claims for members of large commercial and Medicare Advantage health plans. Clinformatics® Data Mart is statistically de-identified under the Expert Determination method consistent with HIPAA and managed according to Optum® customer data use agreements. CDM administrative claims submitted for payment by providers and pharmacies are verified, adjudicated and de-identified prior to inclusion. This data, including patient-level enrollment information, is derived from claims submitted for all medical and pharmacy health care services with information related to health care costs and resource utilization. The population is geographically diverse, spanning all 50 states. Optum’s Clinformatics® Data Mart are licensed and were accessed for the study under a data user agreement that does not allow data sharing. The authors obtained access to the data under a data user agreement. Other investigators engaging in a similar license and data user agreement would be able to access the same data if they purchased access for the same years of data and files. Investigators not engaging in a license and data user agreement would not be able to access the data as the data are not publicly available. Investigators interested in obtaining access can contact optum at 1-866-306-1321 or connected@optum.com.

Funding: This work was funded by the National Heart, Lung and Blood Institute (grants K01HL142847 and R01HL15705). Dr. Benjamin is funded by the National Heart, Lung and Blood Institute (R01HL092577); and the American Heart Association (AHA_18SFRN34110082). Dr. Magnani is funded by the National Heart, Lung and Blood Institute (R33HL144669 and R01HL143010). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Hernandez has received consulting fees from Pfizer and Bristol Myers Squibb, outside of the submitted work. Our conflicts do not alter our adherence to PLOS ONE policies on sharing data and materials.