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. 2022 Nov 3;22(1):2015.
doi: 10.1186/s12889-022-14403-2.

Global, regional, and national burden of disease study of atrial fibrillation/flutter, 1990-2019: results from a global burden of disease study, 2019

Hong Li #  1 , Xuejing Song #  1 , Yi Liang  1 , Xue Bai  2 , Wu-Sha Liu-Huo  2 , Chao Tang  2 , Wen Chen  1 , Lizhi Zhao  3
Affiliations

Global, regional, and national burden of disease study of atrial fibrillation/flutter, 1990-2019: results from a global burden of disease study, 2019

Hong Li et al. BMC Public Health. .

Abstract

Background: Data from the Global Burden of Disease, Injury, and Risk Factor Study 2019 (GBD 2019) was used to assess the burden and change in prevalence, incidence, deaths, disability-adjusted life years, and risk factors for atrial fibrillation/flutter in 204 countries and territories between 1990 and 2019.

Methods: Incidence, prevalence, deaths, disability-adjusted life years (DALYs), and their age-standardized rates of AF/AFL were analyzed by age, sex, socio-demographic index (SDI), and human development index (HDI) using the Global Burden of Disease study 2019 (GBD2019) results，and risk factors for AF/AFL (mainly high systolic blood pressure, high body-mass index, alcohol use, smoking and diet high in sodium) were differentially analyzed.

Results: There are 59.70 million (95% uncertainty interval (UI) 45.73-75.29 million) AF/AFL patients worldwide in 2019, with 4.72 million (95% uncertainty interval (UI) 3.64-5.96 million) new cases and 0.315 million deaths (95% uncertainty interval (UI) 0.268-0.361 million) and 8.39 million disability-adjusted years (95% uncertainty interval (UI) 6.69-10.54 million). The highest risk factor for deaths, DALYs attributable to AF/AFL in 2019 was high systolic blood pressure, high body-mass index, alcohol use, smoking, and diet high in sodium. It is estimated that between 2030 and 2034, the total incidence of male AF/ AFL will be 16.08 million, and the total number of deaths will be 1.01 million. For females, the total number of incidence is 16.85 million, and the total number of deaths is 1.49 million.

Conclusions: AF/AFL remains a major global public health problem, although the ASR of prevalence, incidence, and DALY at the worldwide level showed a decreasing trend from 1990 to 2019(the ASR of deaths increased slightly). However, the unfavorable trend observed in this study in countries with lower SDI suggests that current prevention and treatment strategies should be reoriented. Some countries should develop more targeted and specific strategies to prevent the increase of AF/AFL.

Keywords: Age-standardised rate; Atrial fibrillation/flutter; DALYs; Deaths; Incidence; Prevalence; Risk factor.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships.

Figures

Fig. 1
Fig. 1
Age-standardized rate of incidence, prevalence, deaths, and DALYs change curves for AF/AFL patients from 1990 to 2019(a: Incidence;b: Prevalence;c: Deaths;d: DALYs)
Fig. 2
Fig. 2
The number of AF/AFL patients with incidence, prevalence, deaths, and DALYs and their ASR in each age group (per 5-year), the number on the left side and the ASR on the right side
Fig. 3
Fig. 3
The number of AF/AFL patients of each age group (per 5-year cohort) in males and females with incidence, prevalence, death, and DALYs and their ASR, with the number on the left side and the ASR on the right side, with females in blue and males in red
Fig. 4
Fig. 4
Global age-standardized prevalence of AF/AFL for both sexes in 204 countries and territories. a Age-standardized prevalence of AF/ AFL in 1990, b age-standardized prevalence of AF/AFL in 2019,c the relative change in prevalence of AF/AFL between 1990 and 2019, and d The EAPC of the prevalence of AF/AFL between 1990 and 2019. AF/AFL, atrial fibrillation/atrial flutter; EAPC, estimated annual percentage change
Fig. 5
Fig. 5
Age-standardised DALYs rates for AF/AFL for 21 GBD regions (a) and 204 countries and territories (b) by Socio-demographic Index, 1990–2019 Expected values based on Socio-demographic Index and disease rates in all locations are shown as the black line. DALYs = disability-adjusted life-years. GBD = Global Burden of Diseases, Injuries, and Risk Factors Study
Fig. 6
Fig. 6
The correlation between EAPC and AF/AFL ASR in 1990 (a) and HDI in 2019 (b). The circles represent countries that were available on HDI data. The size of circle is increased with the cases of AF/AFL. The ρ indices and p-values presented in (a) and (b) were derived from Pearson correlation analysis. ASR, agestandardized rate; EAPC, estimated annual percentage change; HDI, human development index
Fig. 7
Fig. 7
Proportion of AF/AFL DALYs and Deaths attributable to high SBP, smoking, alcohol use, high BMI, and diet high in sodium, for 21 GBD regions, SBP = systolic blood pressure. BMI = body-mass index. DALY = disability-adjusted life-year. GBD = Global Burden of Diseases, Injuries, and Risk Factors Study
See this image and copyright information in PMC

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