Epidemiology of atrial fibrillation: European perspective

Abstract

In the last 20 years, atrial fibrillation (AF) has become one of the most important public health problems and a significant cause of increasing health care costs in western countries. The prevalence of AF is increasing due to our greater ability to treat chronic cardiac and noncardiac diseases, and the improved ability to suspect and diagnose AF. At the present time, the prevalence of AF (2%) is double that reported in the last decade. The prevalence of AF varies with age and sex. AF is present in 0.12%-0.16% of those younger than 49 years, in 3.7%-4.2% of those aged 60-70 years, and in 10%-17% of those aged 80 years or older. In addition, it occurs more frequently in males, with a male to female ratio of 1.2:1. The incidence of AF ranges between 0.21 and 0.41 per 1,000 person/years. Permanent AF occurs in approximately 50% of patients, and paroxysmal and persistent AF in 25% each. AF is frequently associated with cardiac disease and comorbidities. The most common concomitant diseases are coronary artery disease, valvular heart disease, and cardiomyopathy. The most common comorbidities are hypertension, diabetes, heart failure, chronic obstructive pulmonary disease, renal failure, stroke, and cognitive disturbance. Paroxysmal AF occurs in younger patients and with a reduced burden of both cardiac disease and comorbidities. Generally, the history of AF is long, burdened by frequent recurrences, and associated with symptoms (in two thirds of patients). Patients with AF have a five-fold and two-fold higher risk of stroke and death, respectively. We estimate that the number of patients with AF in 2030 in Europe will be 14-17 million and the number of new cases of AF per year at 120,000-215,000. Given that AF is associated with significant morbidity and mortality, this increasing number of individuals with AF will have major public health implications.

Keywords: atrial fibrillation; epidemiology; mortality; risk factors; stroke.

Figure 1

Prevalence of atrial fibrillation in European countries.

Figure 2

Frequency of the different types of atrial fibrillation. Abbreviations: ATRIUM, OutpAtienT RegIstry Upon Morbidity of atrial fibrillation; ISAF, Italian Survey of Atrial Fibrillation management; Euro Heart S, Euro Heart Survey; AFNET, Central Registry of the German Competence Network on Atrial Fibrillation; ATA-AF, AntiThrombotic Agents in Atrial Fibrillation; pts, patients; Parox, paroxysmal; Pers, persistent; Perm, permanent.