Global burden of atrial fibrillation/atrial flutter and its attributable risk factors from 1990 to 2021

Abstract

Aims: To devise effective preventive measures, a profound understanding of the evolving patterns and trends in atrial fibrillation (AF) and atrial flutter (AFL) burdens is pivotal. Our study was designed to quantify the burden and delineate the risk factors associated with AF and AFL across 204 countries and territories spanning 1990-2021.

Methods and results: Data pertaining to AF and AFL were sourced from the Global Burden of Disease Study 2021. The burden of AF/AFL was evaluated using metrics such as incidence, disability-adjusted life years (DALYs), deaths, and their corresponding age-standardized rates (ASRs), stratified by age, sex, socio-demographic index (SDI), and human development index (HDI). The estimated annual percentage change was employed to quantify changes in ASRs. Population attributable fractions were calculated to determine the proportional contributions of major risk factors to age-standardized AF/AFL deaths. This analysis encompassed the period from 1990 to 2021. Globally, in 2021, there were 4.48 million incident cases [95% uncertainty interval (UI): 3.61-5.70], 8.36 million DALYs (95% UI: 6.97-10.13) and 0.34 million deaths (95% UI: 0.29-0.37) attributed to AF/AFL. The AF/AFL burden in 2021, as well as its trends from 1990 to 2021, displayed substantial variations based on gender, SDI quintiles, and geographical regions. High systolic blood pressure emerged as the leading contributor to age-standardized AF/AFL incidence, prevalence, death, and DALY rate globally among all potential risk factors, followed closely by high body mass index.

Conclusion: Our study underscores the enduring significance of AF/AFL as a prominent public health concern worldwide, marked by profound regional and national variations. Despite the substantial potential for prevention and management of AF/AFL, there is a pressing imperative to adopt more cost-effective strategies and interventions to target modifiable risk factors, particularly in areas where the burden of AF/AFL is high or escalating.

Keywords: Atrial fibrillation/flutter; Deaths; Disability-adjusted life years; Global Burden of Disease; Incidence; Risk factors.

Graphical Abstract

Figure 1

Age-standardized rate of incidence, prevalence, deaths, and DALYs change curves for AF/AFL patients from 1990 to 2021 (A: incidence; B: prevalence; C: deaths; D: DALYs), AF, atrial fibrillation; AFL, atrial flutter; DAYLs, disability-adjusted life years.

Figure 2

Change in numbers of incidence, prevalence, deaths, and DALYs for AF/AFL patients across 204 countries and territories for both sexes from 1990 to 2021, AF, atrial fibrillation; AFL, atrial flutter; DAYLs, disability-adjusted life years.

Figure 3

The EAPC of AF/AFL in 204 countries and territories between 1990 and 2019, AF, atrial fibrillation; AFL, atrial flutter; EAPC, estimated annual percentage change.

Figure 4

Age-standardized rate and numbers of incidence, prevalence, deaths, and DALYs of AF/AFL in 204 countries and territories in 2021, AF, atrial fibrillation; AFL, atrial flutter; DAYLs, disability-adjusted life years.