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Review
. 2008 May;14(3):143-50.
doi: 10.1097/NRL.0b013e31815cffae.

Clinical epidemiology of atrial fibrillation and related cerebrovascular events in the United States

Kamakshi Lakshminarayan  1 , David C Anderson, Charles A Herzog, Adnan I Qureshi
Affiliations
Review

Clinical epidemiology of atrial fibrillation and related cerebrovascular events in the United States

Kamakshi Lakshminarayan et al. Neurologist. 2008 May.

Abstract

Background: Atrial fibrillation (AF) is an important, independent risk factor for stroke and is estimated to cause a 5-fold increase in ischemic stroke risk. The aim of this article is to describe the changing epidemiology of AF in the United States and to assess the implications for stroke prevention and treatment.

Review summary: AF prevalence is increasing in the general population. This is likely due to the aging of the population, the improvements in coronary care and the rising prevalence of AF risk factors such as diabetes. Risk factors such as rheumatic heart disease and hypertension have decreased in prevalence over the past few decades. However, novel risk factors such as obesity and possibly the metabolic syndrome have been identified and these have the potential to further increase AF prevalence. The utilization of warfarin has improved and this is reflected in falling ischemic stroke rates in the AF population. There is evidence for an increased incidence of anticoagulant associated intraparenchymal hemorrhages during the 1990s.

Conclusions: Although the decline in stroke rates in AF is laudable, the rising prevalence of AF, the changing profile of risk factors, and the recent plateauing of warfarin use indicate that stroke in AF patients will continue to be a significant public health problem.

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Conflict of interest statement

Kamakshi Lakshminarayan, David C. Anderson, and Adnan I. Qureshi report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Projected number of adults with atrial fibrillation in the United States between 1995 and 2050. Upper and lower curves represent the upper and lower scenarios based on sensitivity analyses. Reprinted with permission from JAMA. 2001;285:2370–2375. Copyright © 2001, American Medical Association. All rights reserved.
FIGURE 2
FIGURE 2
Conceptual model of population trends in atrial fibrillation (AF) risk factors underlying the anticipated increase in AF burden in future decades. HTN = hypertension, DM = diabetes mellitus, CC = improved coronary care, VHD = valvular heart disease, HF = heart failure.
FIGURE 3
FIGURE 3
Age-specific atrial fibrillation incidence in various epidemiological studies.,, CHS = Cardiovascular Health Study.
FIGURE 4
FIGURE 4
Trends in warfarin use and stroke rates in atrial fibrillation patients in the General Medicare population. Reprinted with permission from Stroke. 2006;37:1969–1974.
See this image and copyright information in PMC

References

    1. Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text. A report of the American college of Cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to revise the 2001 guidelines for the management of patients with atrial fibrillation) developed in collaboration with the European heart rhythm association and the heart rhythm society. Europace. 2006;8:651–745. - PubMed
    1. 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;285:2370–2375. - PubMed
    1. Chugh SS, Blackshear JL, Shen WK, et al. Epidemiology and natural history of atrial fibrillation: clinical implications. J Am Coll Cardiol. 2001;37:371–378. - PubMed
    1. Lakshminarayan K, Solid CA, Collins AJ, et al. Atrial fibrillation and stroke in the general Medicare population: a 10-year perspective (1992 to 2002) Stroke. 2006;37:1969–1974. - PubMed
    1. Furberg CD, Psaty BM, Manolio TA, et al. Prevalence of atrial fibrillation in elderly subjects (the cardiovascular health study) Am J Cardiol. 1994;74:236–241. - PubMed

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