Heart failure & cardiomyopathies
Global burden of heart failure attributable to atrial fibrillation and flutter, insights from Global Burden of Disease (GBD) 2021
Authors' conclusion
AF/AFL is a major and growing driver of global HF burden, projected to affect 1.3 million individuals by 2040, with disproportionate impact in older adults (≥65 years) and high-SDI regions. Integrating standardized AF management-including systematic screening, anticoagulation, and early rhythm control-into HF prevention pathways represents a critical strategy to mitigate projected increases.
Study context
- Population
- Heart failure attributable to atrial fibrillation/flutter across 204 countries, 1990 to 2021, with projections to 2040
- Outcome
- Global AF-attributed heart failure (HF) cases
- Follow-up
- 1990 to 2021
Methodological detailsJoinpoint regression, decomposition analysis, Bayesian age-period-cohort (BAPC) models
- Joinpoint regression
- Decomposition analysis
- Bayesian age-period-cohort (BAPC) models
Main finding
As reported in the abstract
Cases in 1990
162 561
95% UI 120 008–213 951
Cases in 2021
714 137
95% UI 520 543–940 901
Increase
3.4-fold
Observational data: associations, not effects.
Further findings
Sex differences · no significant sex difference in age-standardized rates
- Sex differences — female-to-male ratio at age 65-69
- 1.1
- Sex differences — female-to-male ratio at ≥95 years
- 2.4
Age-standardized prevalence rate (ASPR) · 1990 to 2021
- ASPR 1990
- 5.36 per 100 000
- ASPR 2021
- 8.85 per 100 000
- EAPC
- 1.76%, 95% UI: 1.66-1.85%
Years lived with disability (YLDs) · 1990 to 2021
- YLDs 1990
- 14 615 (95% UI: 8848-23 114)
- YLDs 2021
- 63 943 (95% UI: 39 058-96 196
- EAPC
- 1.76%, 95% CI: 1.67-1.85%
- Increased more than four-fold
Burden in high-SDI regions
- High-SDI ASPR
- 13.97 (95% UI: 10.31 to 18.36) per 100 000
- Epidemiological changes' contribution to case growth in high-SDI regions
- 44%
Joinpoint analysis
- 1990-2007 APC
- 2.12%, P < .05
- 2007-2018 APC
- 1.41%, P < .05
- 2018-2021 APC
- −0.36%, P > .05
Projection · 2040
- Global cases
- 1 307 469 (95% UI: 661 547-1 953 391)
- ASPR
- 8.45 per 100 000 (95% UI: 4.28-12.63)
- Near-doubling of global cases
Original publication
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