Temporal Trend Analysis of Atrial Fibrillation/Flutter Disease Burden in High-Income Countries Between 1990 and 2021

Atrial fibrillation and atrial flutter (AF/AFL) disease is a common arrhythmia that poses a significant health risk to the older population. With an aging population worldwide, the incidence and mortality rates of AF/AFL show notable gender differences, presenting a challenge to public health systems. This study focused on the AF/AFL disease burden trends in high-income European Union 15+ (EU15+) countries.

Data were sourced from the Global Burden of Disease Study (GBD 2021), using age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) by gender for each year from 1990 to 2021 in EU15+ countries; the mortality-incidence index (MII) was calculated. Analyses were conducted using Joinpoint regression software and age-period-cohort (APC) models to evaluate trends in morbidity, annual changes in morbidity (net drift), annual percentage changes in age-specific morbidity (local drift), and period- and cohort-relative risks by gender, allowing the impact of age, period, and cohort effects on morbidity trends to be assessed.

The study found a declining trend in AF/AFL ASIRs and ASMRs in most EU15+ countries, though significant differences were observed between countries. Male ASIRs and ASMRs were generally higher than those of females, though older women often had higher incidence and mortality rates than men. Furthermore, advances in treatment methods, such as updated anticoagulation therapy, radiofrequency ablation, and novel rhythm control drugs, have impacted the changes in disease burden.

Although the AF/AFL disease burden has declined in more than half of the high-income EU15+ countries, there are significant differences in trend changes between countries. This decline may be due to advances in treatment, such as newer anticoagulation therapies, radiofrequency ablation techniques, and the use of novel cardioverter drugs. Trend changes with unique characteristics may be related to the healthcare system of each country, socioeconomic factors, and the promotion of health education. This study also identified gender differences, with older women at greater risk of developing AF/AFL, implying that the older female population faces the need for enhanced risk assessment and management.