CurrentCardio
Get Weekly

Heart failure & cardiomyopathiesCohort study

Global burden of heart failure attributable to atrial fibrillation and flutter, insights from Global Burden of Disease (GBD) 2021

ESC Heart FailPublished

  • Global Burden of Disease (GBD) 2021 data analysis
  • Joinpoint regression
  • decomposition analysis
  • Bayesian age-period-cohort (BAPC) models
Read the original article ↗

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

Main finding

As reported in the abstract

Global AF-attributed heart failure (HF) cases · 1990 to 2021

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

Global burden of heart failure attributable to atrial fibrillation and flutter, insights from GBD 2021. ESC Heart Fail. Published 30 March 2026. doi:10.1093/eschf/xvag094
Read the original article ↗PubMedCite RIS · BibTeX

Summarised from the published abstract; every number is checked against it