The Danish Atrial Fibrillation Registry: A Multidisciplinary National Pragmatic Initiative for Monitoring and Supporting Quality of Care Based on Data Retrieved from Administrative Registries

Abstract

Aim

The Danish Atrial Fibrillation (AF) Registry monitors and supports improvement of quality of care for all AF patients in Denmark. This report describes the registry’s administrative and organizational structure, data sources, data flow, data analyses, annual reporting, and feedback between the registry, clinicians, and the administrative system. We also report the selection process of the quality indicators and the temporal trends in results from 2017–2021.

Methods and Results

The Danish AF Registry aims for complete registration and monitoring of care for all patients diagnosed with AF in Denmark. Administrative registries provide data on contacts to general practice, contacts to private cardiology practice, hospital contacts, medication prescriptions, updated vital status information, and biochemical test results. The Danish Stroke Registry provides information on stroke events. From 2017 to 2021, the proportion with a reported echocardiography among incident AF patients increased from 39.9% (95% CI: 39.3–40.6) to 82.6% (95% CI: 82.1–83.1). The initiation of oral anticoagulant therapy among patients with incident AF and a CHA₂DS₂-VASc score of ≥1 in men and ≥2 in women increased from 85.3% (95% CI: 84.6–85.9) to 90.4% (95% CI: 89.9–91.0). The 1-year and 2-year persistence increased from 85.2% (95% CI: 84.5–85.9) to 88.7% (95% CI: 88.0–89.3), and from 85.4% (95% CI: 84.7–86.2) to 88.2% (95% CI: 87.5–88.8), respectively. The 1-year risk of ischemic stroke among prevalent patients with AF decreased from 0.88% (95% CI: 0.83–0.93) to 0.71% (95% CI: 0.66–0.75). Variation in clinical performance between the five administrative Danish regions was reduced.

Conclusion

Continuous nationwide monitoring of quality indicators for AF originating from administrative registries is feasible and supportive of improvements of quality of care.

Keywords:

• atrial fibrillation
• quality indicators
• quality of care

Data Sharing Statement

Individual-level data cannot be shared in public due to national legislation. Data can be accessed by application to the Danish Health Data Authority.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

L.F reports being supported by a research grant from the Health Research Foundation of Central Denmark Region. Consultant for BMS/Pfizer and AstraZeneca. A.B reports lecture fees from Boehringer-Ingelheim and Bristol-Myers Squibb; research grants from Theravance, The Zealand Region, the Canadian Institutes of Health Research, and the Danish Heart Foundation, grants from Independent Research Fund Denmark outside this work. DD reports lecture fees from BMS and Pfizer. SPJ reports grants from EU, institutional research grant from BMS/Pfizer. Consultant work for BMS/Pfizer. NV reports being supported by a research grant from the Danish Cardiovascular Academy (PD2Y-2022002-DCA). Consultant for AstraZenaca. No fees were received personally. The authors report no other conflicts of interest in this work.