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

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.

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.

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.

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.