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Review
. 2020 Jun 19;127(1):4-20.
doi: 10.1161/CIRCRESAHA.120.316340. Epub 2020 Jun 18.

Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights

Jelena Kornej #  1 , Christin S Börschel #  2   3 , Emelia J Benjamin  1   4 , Renate B Schnabel  2   3
Affiliations
Review

Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights

Jelena Kornej et al. Circ Res. .

Abstract

Accompanying the aging of populations worldwide, and increased survival with chronic diseases, the incidence and prevalence of atrial fibrillation (AF) are rising, justifying the term global epidemic. This multifactorial arrhythmia is intertwined with common concomitant cardiovascular diseases, which share classical cardiovascular risk factors. Targeted prevention programs are largely missing. Prevention needs to start at an early age with primordial interventions at the population level. The public health dimension of AF motivates research in modifiable AF risk factors and improved precision in AF prediction and management. In this review, we summarize current knowledge in an attempt to untangle these multifaceted associations from an epidemiological perspective. We discuss disease trends, preventive opportunities offered by underlying risk factors and concomitant disorders, current developments in diagnosis and risk prediction, and prognostic implications of AF and its complications. Finally, we review current technological (eg, eHealth) and methodological (artificial intelligence) advances and their relevance for future prevention and disease management.

Keywords: artificial intelligence; atrial fibrillation; incidence; prevalence; risk factors.

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Conflict of interest statement

Conflicts of interest

Starting January 2020, Dr. Benjamin serves as an uncompensated member for the MyHeartLab Steering Committee. The MyHeartLab Study is a PI-initiated study from the University of California San Francisco: PI, Jeffrey Olgin, MD, through a research grant to UCSF from Samsung.

Figures

Figure 1.
Figure 1.. Challenges in AF epidemiology.
Prevention in AF becomes important because of epidemic character of disease development. While primary and secondary prevention play a crucial role in older individuals with cardiovascular- and non-cardiac diseases, primordial and primary prevention are fundamental in young adults and individuals without known co-morbidities. Personal, lifestyle, and social factors as well as societal and health system interventions remain essential prevention targets. (Illustration credit: Ben Smith)
Figure 2.
Figure 2.. Relationship between physical activity, obesity and lean body mass in AF.
Moderate physical activity (PA) should be recommended for all AF prevention levels – primordial, primary, and secondary. Low and extreme PA predisposes to obesity (fat) or excessive muscle (lean body) mass, respectively. Through complex pathophysiological mechanisms, both are risk factors for AF. (Illustration credit: Ben Smith)
Figure 3.
Figure 3.. Athletes’ heart and AF.
Cardiac adaptations to exercise are considered as beneficial, although vigorous physical activity and prolonged endurance exercise, may lead to cardiac ‘overadaptation’ or even ‘maladaptation’ and (patho)-physiological changes, which facilitate AF initiation and perpetuation. (Illustration credit: Ben Smith)
Figure 4.
Figure 4.. Association between AF and system diseases.
Atrial fibrillation (AF) is a multisystem disorder with complex relations to associated diseases, risk factors and the environment. An improved comprehension of this interplay may help improve risk assessment and management of AF and its comorbidities in the future. (Illustration credit: Ben Smith)
See this image and copyright information in PMC

References

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