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Global Epidemiological Transition of Atrial Fibrillation/Flutter (1990-2021): Multidimensional Burden Dynamics and

Jingmei Sun¹, Yingying Lu¹, Yifan Bao¹

¹Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, 150001 Harbin, Heilongjiang, China.

Reviews in Cardiovascular Medicine

|January 12, 2026

Abstract

Background:

This study aimed to decode the spatiotemporal trajectory of atrial fibrillation/flutter (AF/AFL) burden (1990-2021) through hierarchical quantification of socioeconomic health gradients and Bayesian projection modeling across 204 countries and territories until 2036.

Methods:

This study, based on data from the 2021 Global Burden of Disease (GBD) study, systematically investigates the geopolitical and temporal dynamics of AF/AFL from 1990 to 2021. This study quantified the impact of population structure, age distribution, and disease rates on the disease burden, assessed the inequality of burden among different countries, and predicted the disease trends for the next 15 years.

Results:

From 1990 to 2021, when the age-standardized death rate (ASDR) was the only indicator showing an upward trend (estimated annual percentage change (EAPC) = 0.1 (0.06-0.13)), the absolute number of AF/AFL cases continued to rise. Decomposition analysis revealed that population growth (43.17%) and aging (56.31%) were the primary drivers of the global AF/AFL burden in 2021. The study found that from 1990 to 2021, inequality in the social indicators index (SDI) worsened, whereas the slope index of inequality (SII) values for AF/AFL incidence (41.68 vs. 81.71), prevalence (499.54 vs. 1076.65), mortality (3.23 vs. 8.50), and disability-adjusted life years (DALYs) (82.36 vs. 189.81) all increased. Notably, the global AF/AFL burden is projected to continue rising through 2036. The age-standardized incidence rate (ASIR) (52.36 vs. 56.07) for AF/AFL is expected to increase annually, while the ASDR (4.12 vs. 3.93) and age-standardized DALYs rate (ASDAR) (107.45 vs. 90.87) are projected to decline. However, the number of cases is expected to maintain growth.

Conclusions:

This study shows that the global burden of AF/AFL has an overall increasing trend from 1990 to 2021, primarily driven by population growth and aging. Countries with a high SDI bear a disproportionately high burden of AF/AFL, while SDI-related inequalities among countries have worsened over time. This study highlights the significant challenges in the prevention and management of AF/AFL, including the rising number of cases and the unequal distribution of the subsequent burden worldwide. These findings may be instructive for developing more effective public health policies and reasonably allocating medical resources.

Keywords:

atrial fibrillation atrial flutter disability-adjusted life years incidence prevalence

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