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. 2025 Feb 5;27(2):euaf027.
doi: 10.1093/europace/euaf027.

Global, regional, and national burden of atrial fibrillation and atrial flutter from 1990 to 2021: sex differences and global burden projections to 2046-a systematic analysis of the Global Burden of Disease Study 2021

Siyuan Tan  1   2   3   4 , Jiabao Zhou  1   2   3   4 , Tevit Veang  1   2   3   4 , Qiuzhen Lin  1   2   3   4 , Qiming Liu  1   2   3   4
Affiliations

Global, regional, and national burden of atrial fibrillation and atrial flutter from 1990 to 2021: sex differences and global burden projections to 2046-a systematic analysis of the Global Burden of Disease Study 2021

Siyuan Tan et al. Europace. .

Abstract

Aims: Atrial fibrillation and atrial flutter (AF/AFL) are critical global health concerns, yet studies on burden trends and sex differences remain limited. This study aims to investigate the global burden trends of AF/AFL, with an in-depth analysis of differences between sexes and future trends, in order to address gaps in the current research field.

Methods and results: This study utilized data from the Global Burden of Disease 2021 study, applying methods such as age-period-cohort analysis and joinpoint regression models to evaluate trends and sex differences in the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of AF/AFL among individuals aged 30 and above from 1990 to 2021, and employed Bayesian age-period-cohort (BAPC) analysis to predict future trends from 2022 to 2046. In 2021, AF/AFL affected around 52.6 million people globally, with significant increases in cases, deaths, and DALYs since 1990. While the age-standardized prevalence rate (ASPR) remained stable, the age-standardized incidence rate (ASIR) slightly declined, and the age-standardized mortality rate (ASMR) increased. Moreover, there were significant differences in the disease burden between male and female patients. Males had higher prevalence and DALYs, with older age contributing to higher rates. Key risk factors included high systolic blood pressure, body mass index (BMI), and alcohol use, with female patients exhibiting a higher age-standardized rates associated with elevated BMI compared with their male counterparts. Bayesian age-period-cohort predicted stable ASPR and ASIR in males but rising rates in females, with ASMR expected to decline for both sexes.

Conclusion: The global burden of AF/AFL is rising, particularly among women, and in low-socio-demographic index regions. This underscores the urgent need for targeted prevention strategies and optimized management of modifiable risk factors, with a specific focus on these vulnerable groups.

Keywords: Atrial fibrillation and atrial flutter; Future prediction; Global disease burden; Sex differences.

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Conflict of interest statement

Conflict of interest: All authors hereby attest that they do not have any conflicts of interest related to this article.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Trends in global AF/AFL burden from 1990 to 2021. (A–D) Trends in both sexes burden for AF/AFL, (A) ASPR; (B) ASIR; (C) ASMR; (D) ASDR; (E–H) trends in male burden for AF/AFL, (E) ASPR; (F) ASIR; (G) ASMR; (H) ASDR; (I–L), (I) ASPR; (J) ASIR; (K) ASMR; and (L) ASDR. ASDR, age-standardized rates of disability-adjusted life years; ASIR, age-standardized incidence rates; ASMR, age-standardized mortality rates; ASPR, age-standardized prevalence rates; SDI, social development index.
Figure 2
Figure 2
Age-related trends in the global AF/AFL burden in 2021. (A–D) Age-related trends in both sexes burden for AF/AFL, (A) prevalence rates; (B) incidence rates; (C) deaths rates and (D) DALYs rates in age groups; (E–H) age-related trends in different sex burden for AF/AFL, (E) prevalence rates; (F) incidence rates; (G) deaths rates; and (H) DALYs rates in age groups. ASDR, age-standardized rates of disability-adjusted life years; ASIR, age-standardized incidence rates; ASMR, age-standardized mortality rates; SDI, social development index.
Figure 3
Figure 3
Age-period-cohort analysis of the global AF/AFL burden from 1992 to 2021. (A) Local drift net drift; (B) longitudinal age curves; and (C) period-relative risk. DALYs, disability-adjusted life years.
Figure 4
Figure 4
Estimated attributable risk factors for global AF/AFL burden in 2021. Risk per cent of ASMR (A) and ASDR (B). ASDR, age-standardized rates of disability-adjusted life years; ASMR, age-standardized mortality rates; SDI, social development index.
Figure 5
Figure 5
Temporal joinpoint analysis of the AF/AFL burden temporal trends from 1990 to 2021. (A) ASPR; (B) ASIR; (C) ASMR; and (D) ASDR. ASDR, age-standardized rates of disability-adjusted life years; ASIR, age-standardized incidence rates; ASMR, age-standardized mortality rates; ASPR, age-standardized prevalence rates.
Figure 6
Figure 6
Projected global burden for AF/AFL by sex from 1990 to 2046 based on the BAPC model. (A–D) Male; (E–H) female; (A, E) ASPR; (B, F) ASIR; (C, G) ASMR; and (D, H) ASDR. ASDR, age-standardized rates of disability-adjusted life years; ASIR age-standardized incidence rates; ASMR, age-standardized mortality rates; ASPR, age-standardized prevalence rates; ASR, age-standardized rates.
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