Atrial fibrillation and flutter (AF/AFL) are common conditions that can lead to significant morbidity and mortality. Evidence on the disparities in AF/AFL prevalence trends and risk factors on a global level is sparse.
Methods
Data about the AF/AFL burden from the GBD dataset was analysed for the years 1990-2019. For the analysis countries were grouped into low, lower middle, upper middle and high national income classes according to World Bank categories. Additionally, this data was supplemented with WHO and World Bank information.
Results
The prevalence of AF/AFL has more than doubled (+120.7%) between 1990 and 2019 in all income groups worldwide, though with a larger increment in middle income countries (+146.6% in lower middle and +145.2% in upper middle income countries). A further increase in global AF/AFL burden can be expected in the future due to a projected increase in the elderly population until 2050, with the greatest estimated growth in middle income countries. In 2019 there were almost 60 million AF/AFL cases worldwide. Almost two third (63.4%) of these global AF/AFL cases originate from middle income countries. The absolute AF/AFL prevalence is highest in upper middle income countries since 2014. In contrast, the relative prevalence shows an ordered gradation with a decrease of AF/AFL prevalence rate from high to low national income. Low income countries have the lowest AF/AFL prevalence, both in absolute and relative numbers. 73.0% of global AF/AFL cases occur in the age group of 65 years and above. On a country-level analysis, AF/AFL prevalence appears to be correlated with life expectancy and medical doctor rate. The most relevant modifiable AF/AFL risk factors are unevenly distributed among income classes, with elevated blood pressure as the only risk factor that becomes less common with increasing income. The risk factors average BMI, alcohol consumption and insufficient physical activity are most prevalent in high income countries, whereas current tobacco use is most common in low income countries and raised fasting blood glucose highest in upper middle income countries. The development of these risk factors over time differed between income classes.
Conclusion
The global burden of AF/AFL is increasing in all income groups, more pronounced in middle income countries with a further growth to be expected. Most individuals with AF/AF come from middle income countries. Underdiagnosis of AF/AFL in countries with less income can be assumed. The risk factor distribution varies between income groups and may require targeted preventive measures.
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