Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 30;25(3):793-803.
doi: 10.1093/europace/euac237.

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

Xin-Jiang Dong  1 , Bei-Bei Wang  2 , Fei-Fei Hou  3 , Yang Jiao  4 , Hong-Wei Li  1 , Shu-Ping Lv  5 , Fei-Hong Li  6
Affiliations

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

Xin-Jiang Dong et al. Europace. .

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.

Keywords: Atrial fibrillation/atrial flutter; Deaths; Disability-adjusted life years; Global burden; Incidence; Risk factors.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Trends in numbers and age-standardized rates of incident cases (A), deaths (B), and disability-adjusted life years cases (C) of atrial fibrillation/atrial flutter at the global level, 1990–2019. Error bars indicate the 95% uncertainty interval (UI) for numbers. Shading indicates the 95% UI for rates.
Figure 2
Figure 2
Age-specific numbers and rates of incident cases (A), disability-adjusted life years cases (B), and deaths (C) of atrial fibrillation/atrial flutter by sex, 2019. Error bars indicate the 95% uncertainty interval (UI) for numbers. Shading indicates the 95% UI for rates.
Figure 3
Figure 3
Trend in age-standardized incidence (A), disability-adjusted life years (B), and death (B) rates of atrial fibrillation/atrial flutter globally and for 21 GBD regions by socio-demographic index, 1990–2019. For each region, points from left to right depict estimates from each year from 1990 to 2019. GBD, Global Burden of Disease, Injuries, and Risk Factors Study.
Figure 4
Figure 4
Age-standardized incidence (A), DALYs (B), and death (C) rates of is atrial fibrillation /atrial flutter across 195 countries and territories for both sexes, 2019. DALYs, disability-adjusted life years.
Figure 5
Figure 5
Percentage contributions of major risk factors to age-standardized death of atrial fibrillation/atrial flutter, 1990–2019. SDI, Socio-Demographic Index.
See this image and copyright information in PMC

References

    1. Ruddox V, Sandven I, Munkhaugen J, Skattebu J, Edvardsen T, Otterstad JE. Atrial fibrillation and the risk for myocardial infarction, all-cause mortality and heart failure: a systematic review and meta-analysis. Eur J Prev Cardiol 2017;24:1555–66. - PMC - PubMed
    1. Stewart S, Hart C, Hole D, McMurray J. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med 2002;113:359–64. - PubMed
    1. Dai H, Zhang Q, Much A, Maor E, Segev A, Beinart R. Global, regional, and national prevalence, incidence, mortality, and risk factors for atrial fibrillation, 1990–2017: results from the Global Burden of Disease Study 2017. Eur Heart J Qual Care Clin Outcomes 2021;7:574–82. - PMC - PubMed
    1. Wang L, Ze F, Li J, Mi L, Han B, Niu H. Trends of global burden of atrial fibrillation/flutter from Global Burden of Disease Study 2017. Heart 2021;107:881–7. - PubMed
    1. Naccarelli G, Varker H, Lin J, Schulman KL. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol 2009;104:1534–9. - PubMed