Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study

Abstract

Background: The global burden of atrial fibrillation (AF) is unknown.

Methods and results: We systematically reviewed population-based studies of AF published from 1980 to 2010 from the 21 Global Burden of Disease regions to estimate global/regional prevalence, incidence, and morbidity and mortality related to AF (DisModMR software). Of 377 potential studies identified, 184 met prespecified eligibility criteria. The estimated number of individuals with AF globally in 2010 was 33.5 million (20.9 million men [95% uncertainty interval (UI), 19.5-22.2 million] and 12.6 million women [95% UI, 12.0-13.7 million]). Burden associated with AF, measured as disability-adjusted life-years, increased by 18.8% (95% UI, 15.8-19.3) in men and 18.9% (95% UI, 15.8-23.5) in women from 1990 to 2010. In 1990, the estimated age-adjusted prevalence rates of AF (per 100 000 population) were 569.5 in men (95% UI, 532.8-612.7) and 359.9 in women (95% UI, 334.7-392.6); the estimated age-adjusted incidence rates were 60.7 per 100 000 person-years in men (95% UI, 49.2-78.5) and 43.8 in women (95% UI, 35.9-55.0). In 2010, the prevalence rates increased to 596.2 (95% UI, 558.4-636.7) in men and 373.1 (95% UI, 347.9-402.2) in women; the incidence rates increased to 77.5 (95% UI, 65.2-95.4) in men and 59.5 (95% UI, 49.9-74.9) in women. Mortality associated with AF was higher in women and increased by 2-fold (95% UI, 2.0-2.2) and 1.9-fold (95% UI, 1.8-2.0) in men and women, respectively, from 1990 to 2010. There was evidence of significant regional heterogeneity in AF estimations and availability of population-based data.

Conclusions: These findings provide evidence of progressive increases in overall burden, incidence, prevalence, and AF-associated mortality between 1990 and 2010, with significant public health implications. Systematic, regional surveillance of AF is required to better direct prevention and treatment strategies.

Keywords: atrial fibrillation; epidemiology; incidence; prevalence; risk factors, prevention.

Conflict of interest statement

Conflict of Interest Disclosures: None.

Figures

Figure 1

Conceptual disease model. Flow-chart illustrating the conceptual disease model utilized (DisMod-MR software). The model includes the number of people without the disease (AF in this case), the number of people with the disease, the number of deaths associated with the disease, and the number of deaths from all other causes. The transitions between these states are represented by i: incidence, r: remission, ƒ: case fatality, and m: all other mortality. In the case of AF, remission was assumed to be zero. (Modified from: Barendregt et al. A generic model for the assessment of disease epidemiology: the computational basis of DisMod II. Popul Health Metr. 2003 Apr 14; 1:4. Copyright © 2003 Barendregt et al; licensee BioMed Central Ltd.) (AF- Atrial Fibrillation).

Figure 2

World Map Showing the Age-adjusted Prevalence rates (per 100,000 population) of AF in the 21 Global Burden of Disease (GBD) regions, 2010 (AF- Atrial Fibrillation).

Figure 3

Prevalence of AF: 1990 to 2010. Estimated age-adjusted global prevalence of Atrial Fibrillation (per 100,000 population) for males and females from 1990 to 2010 (AF- Atrial Fibrillation).

Figure 4

Incidence of AF: 1990 & 2010. Estimated age-adjusted global incidence (per 100,000 person years) for males and females for 1990 and 2010. (AF- Atrial Fibrillation)

Figure 5

Mortality Associated with AF: 1990 to 2010. Estimated age-adjusted mortality (per 100,000 population) associated with AF from 1990 to 2010 (AF- Atrial Fibrillation).

Figure 6

Mortality Associated with AF stratified by sex and type of Region (Developed vs. Developing). Mortality associated with AF was higher in males and females in the Developed regions. The significantly higher mortality in females in the Developing regions is responsible for the overall higher AF-related mortality among females compared to males (AF- Atrial Fibrillation).

Figure 7

Proportion of Global deaths Associated with AF in 2010. The map shows color-coded proportions (in percentages) of global deaths in 2010 associated with AF (AF- Atrial Fibrillation)

Figure 8

DALYs Related to AF. Estimated age-adjusted DALYs (per 100,000) related to AF: 1990 to 2010 (AF- Atrial Fibrillation; DALYs- Disability Adjusted Life-Years)