Epidemiological Analysis and 2040 Projections of Atrial Fibrillation and Flutter in Asia

Atrial fibrillation and flutter (AF/AFL) impose a substantial and growing global burden, yet comprehensive assessments focusing on Asia, accounting for regional heterogeneity, demographic drivers, and future trajectories, remain limited.

This study aims to systematically evaluate the burden of AF/AFL across Asia from 1990 to 2021, to quantify the contributions of demographic and epidemiological drivers, and to project future trends to inform region-specific prevention strategies.

Using Global Burden of Disease 2021 data, we analyzed prevalence, incidence, mortality, and disability-adjusted life years (DALYs) of AF/AFL across 48 Asian countries and territories. Joinpoint regression assessed temporal trends; decomposition analysis quantified contributions of population growth, aging, and epidemiological changes; and auto-regressive integrated moving average models projected burden to 2040.

In 2021, Asia had 25,739,093 (95% uncertainty interval [UI]: 20,431,798-33,586,165) prevalent cases of AF/AFL, with age-standardized rate 529.04 (95% UI: 420.26-680.91) per 100,000. Southeast Asia exhibited the highest age-standardized burden, while only the high-income Asia-Pacific region showed declining trends. Although the burden on male was greater, older females were a group that could not be overlooked. Joinpoint analysis revealed a nonlinear trajectory with accelerated growth after 2014. Decomposition analysis identified population growth and aging as primary drivers. High systolic blood pressure was the leading risk factor, with high body mass index showing the most rapid increase. Projections indicate sustained rises through 2040, with particularly pronounced increases among females.

AF/AFL has become an increasingly severe public health challenge in Asia. Therefore, tailored prevention and control strategies should be developed according to regional characteristics to effectively alleviate its disease burden.