Trends in burden of atrial fibrillation over three decades: a population-based study

Atrial fibrillation (AF) is a common sustained cardiac arrhythmia with increasing prevalence and incidence worldwide. However, long-term trends in AF prevalence, incidence, associated risk factors, and the role of comorbidities, including sex-specific differences is limited.

We included 7750, 7675, and 7121 participants from the population-based Rotterdam Study across three epochs over 3 decades (epoch 1990s: 1989-1993; epoch 2000s: 1997-2001; and epoch 2010s: 2009-2014). We examined trends in incidence rates and estimated incidence rate ratios (IRRs) over time, both overall and stratified by sex. Cox regression were applied to evaluate associations between comorbidities and incident AF to derive HRs with 95% CIs. Population attributable fractions (PAFs) were calculated to quantify the contribution of key comorbidities to AF incidence.

The mean (SD) of age in three epochs was around 70 years (epoch 1990s: 70.3 (9.6), epoch 2000s: 70.0 (8.7) and epoch 2010s: 70.4 (9.8)). The follow-up for each participant was 5 years. The age and sex-adjusted AF incidence rates in three epochs were 36.1, 27.4 and 52.0 per 1000 person-years. The AF incidence rates were 31.4, 22.9 and 44.1 for women and 45.0, 34.7 and 65.6 for men, respectively. Hypertension was the most important contributor to incident AF in all three epochs (PAFs were epoch 1990s: 36.0% (95% CI 24.3% to 54.2%), epoch 2000s: 35.0% (95% CI 14.0% to 59.5%) and epoch 2010s: 42.7% (95% CI 22.6% to 61.0%)), especially in women (epoch 1990s: 46.6% (95% CI 24.0% to 68.3%), epoch 2000s: 38.60% (95% CI 11.9% to 68.9%) and epoch 2010s: 59.9% (95% CI 40.5% to 82.5%)).

The increasing burden of AF over the last three decades for both women and men calls for improved sex-specific AF prevention and management strategies. Hypertension remains to be a principal contributor to the population burden of AF, in particular among women. Effective sex-specific management of hypertension is a promising target in AF prevention strategies.