Global burden of atrial fibrillation/atrial flutter and its attributable risk factors from 1990 to 2019

• Published in: Europace (London, England) Vol. 25; no. 3; pp. 793 - 803
• Main Authors: Dong, Xin-Jiang, Wang, Bei-Bei, Hou, Fei-Fei, Jiao, Yang, Li, Hong-Wei, Lv, Shu-Ping, Li, Fei-Hong
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 30.03.2023
• Subjects: Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Flutter - diagnosis; Atrial Flutter - epidemiology; Clinical Research; Global Burden of Disease; Humans; Incidence; Quality-Adjusted Life Years; Risk Factors; Deaths; Atrial fibrillation/atrial flutter; Disability-adjusted life years; Risk factors; Global burden; Incidence
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euac237

Abstract Aims The aim of this study was to estimate the global burden of atrial fibrillation (AF)/atrial flutter (AFL) and its attributable risk factors from 1990 to 2019. Methods and results The data on AF/AFL were retrieved from the Global Burden of Disease Study (GBD) 2019. Incidence, disability-adjusted life years (DALYs), and deaths were metrics used to measure AF/AFL burden. The population attributable fractions (PAFs) were used to calculate the percentage contributions of major potential risk factors to age-standardized AF/AFL death. The analysis was performed between 1990 and 2019. Globally, in 2019, there were 4.7 million [95% uncertainty interval (UI): 3.6 to 6.0] incident cases, 8.4 million (95% UI: 6.7 to 10.5) DALYs cases, and 0.32 million (95% UI: 0.27 to 0.36) deaths of AF/AFL. The burden of AF/AFL in 2019 and their temporal trends from 1990 to 2019 varied widely due to gender, Socio-Demographic Index (SDI) quintile, and geographical location. Among all potential risk factors, age-standardized AF/AFL death worldwide in 2019 were primarily attributable to high systolic blood pressure [34.0% (95% UI: 27.3 to 41.0)], followed by high body mass index [20.2% (95% UI: 11.2 to 31.2)], alcohol use [7.4% (95% UI: 5.8 to 9.0)], smoking [4.3% (95% UI: 2.9 to 5.9)], diet high in sodium [4.2% (95% UI: 0.8 to 10.5)], and lead exposure [2.3% (95% UI: 1.3 to 3.4)]. Conclusion Our study showed that AF/AFL is still a major public health concern. Despite the advancements in the prevention and treatment of AF/AFL, especially in regions in the relatively SDI quintile, the burden of AF/AFL in regions in lower SDI quintile is increasing. Since AF/AFL is largely preventable and treatable, there is an urgent need to implement more cost-effective strategies and interventions to address modifiable risk factors, especially in regions with high or increased AF/AFL burden.