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Multicenter Study
. 2025 Oct;12(5):3697-3706.
doi: 10.1002/ehf2.15344. Epub 2025 Jun 13.

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
Multicenter Study

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

Yabin Liu et al. ESC Heart Fail. 2025 Oct.

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.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Age‐standardized prevalence rates of heart failure attributable to AF/AFL across 204 countries and territories in 2021. AF, atrial fibrillation; AFL, atrial flutter.
Figure 2
Figure 2
Age‐standardized YLD rates of heart failure attributable to AF/AFL across 204 countries and territories in 2021. AF, atrial fibrillation; AFL, atrial flutter; YLD, years lived with disability.
Figure 3
Figure 3
Age‐specific prevalence rates and numbers of heart failure attributable to AF/AFL by severity in 1990 and 2021. AF, atrial fibrillation; AFL, atrial flutter.
Figure 4
Figure 4
Temporal trends in numbers and age‐standardized rates of AF/AFL‐related heart failure burden by SDI quintile from 1990 to 2021. AF, atrial fibrillation; AFL, atrial flutter; SDI, socio‐demographic index; YLD, years lived with disability.
Figure 5
Figure 5
Trends in age‐standardized prevalence and YLD rates of heart failure attributable to AF/AFL for 21 GBD regions by SDI, 1990–2021. AF, atrial fibrillation; AFL, atrial flutter; GBD, Global Burden of Disease Study; SDI, socio‐demographic index; YLD, years lived with disability.
See this image and copyright information in PMC

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