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
. 2025 Jun 13.
doi: 10.1002/ehf2.15344. Online ahead of print.

Atrial fibrillation and flutter as global drivers of heart failure: Burden and longitudinal trends over three decades

Yabin Liu  1   2   3   4 , Jingsi Duan  1   2   3   4 , Yue Wang  5 , Nicola Luigi Bragazzi  6 , Mengying Huang  1   2   3   4 , Huimin Chen  1   2   3   4 , Haijiang Dai  1   2   3   4 , Cheng Ni  1   2   3   4
Affiliations
Free article

Atrial fibrillation and flutter as global drivers of heart failure: Burden and longitudinal trends over three decades

Yabin Liu et al. ESC Heart Fail. .
Free article

Abstract

Aims: The study aims to comprehensively evaluate the global burden of heart failure attributable to atrial fibrillation (AF) and atrial flutter (AFL) from 1990 to 2021.

Methods: Using data from the Global Burden of Disease Study 2021, we estimated the prevalence and years lived with disability (YLDs) of heart failure attributable to AF/AFL across 204 countries and territories. Estimates were stratified by age, sex and socio-demographic index (SDI). Age-standardized rates per 100 000 population were calculated, and percentage changes between 1990 and 2021 were analysed to assess temporal trends.

Results: In 2021, AF/AFL were responsible for an estimated 714 137.5 [95% uncertainty interval (UI) 520 543.5 to 940 900.6] heart failure cases and 63 942.8 (95% UI 39 057.9 to 96 196.5) YLDs globally. The age-standardized prevalence and YLD rates were 8.85 (95% UI 6.38 to 11.63) and 0.79 (95% UI 0.49 to 1.19) per 100 000 population, respectively. Between 1990 and 2021, global absolute numbers of heart failure cases and YLDs attributable to AF/AFL increased by 339.3% (95% UI 292.7 to 387.0) and 337.5% (95% UI 290.1 to 387.0), respectively. Age-standardized prevalence and YLD rates increased by 65.2% (95% UI 47.7 to 83.8) and 65.4% (95% UI 46.6 to 83.5), respectively. The burden progressively increased with age, peaking among individuals aged ≥95 years. Females experienced a higher burden than males from age 55 years onward, with the greatest disparity observed in the 85-89 years age group. High SDI regions, such as Australasia and Western Europe, exhibited the highest prevalence and YLD rates.

Conclusions: The global burden of heart failure attributable to AF/AFL increased substantially from 1990 to 2021, disproportionately affecting older adults, females aged 55 years and above and populations in high SDI regions. These findings highlight the urgent need for targeted interventions and resource allocation to address the growing challenges, particularly for vulnerable groups.

Keywords: atrial fibrillation and flutter; epidemiology; heart failure; years lived with disability.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

References

    1. Ngo LTH, Peng Y, Denman R, Yang I, Ranasinghe I. Long‐term outcomes after hospitalization for atrial fibrillation or flutter. Eur Heart J 2024;45:2133‐2141. doi:10.1093/eurheartj/ehae204
    1. Ko D, Chung MK, Evans PT, Benjamin EJ, Helm RH. Atrial fibrillation: a review. JAMA 2024; doi:10.1001/jama.2024.22451
    1. Verhaert DVM, Brunner‐La Rocca HP, van Veldhuisen DJ, Vernooy K. The bidirectional interaction between atrial fibrillation and heart failure: consequences for the management of both diseases. Europace 2021;23:ii40‐ii45. doi:10.1093/europace/euaa368
    1. Manolis AS, Manolis TA, Manolis AA, Melita H. Atrial fibrillation‐induced tachycardiomyopathy and heart failure: an underappreciated and elusive condition. Heart Fail Rev 2022;27:2119‐2135. doi:10.1007/s10741‐022‐10221‐1
    1. Diamant MJ, Andrade JG, Virani SA, Jhund PS, Petrie MC, Hawkins NM. Heart failure and atrial flutter: a systematic review of current knowledge and practices. ESC Heart Fail 2021;8:4484‐4496. doi:10.1002/ehf2.13526

LinkOut - more resources