Atrial fibrillation and atrial flutter in China: trends and projections to 2050 from GBD 2023

Atrial fibrillation and atrial flutter (AF/AFL) impose a mounting health burden worldwide, yet no comprehensive study has systematically evaluated their long‑term trajectories and future scenarios for China using the latest Global Burden of Disease (GBD) data. Using the GBD 2023 dataset, we extracted age- and sex-specific burden estimates of AF/AFL for China (1990-2023). Joinpoint regression, age-period-cohort modeling, decomposition analysis, frontier analysis, and autoregressive integrated moving average (ARIMA) forecasting were applied to characterize historical dynamics and future trajectories. In 2023, China had 12.39 million prevalent cases, 1.06 million incident cases, 65,008 deaths, and 1.75 million disability‑adjusted life years (DALYs). Males had higher age‑standardized prevalence rate (ASPR) (614.89 vs. 472.17) and age‑standardized incidence rate (ASIR) (49.22 vs. 43.00), while females had higher age‑standardized mortality rate (ASMR) (3.69 vs. 2.52) per 100,000. The age‑standardized DALY rate (ASDR) was slightly higher in males (79.24) than in females (77.34) per 100,000. The mortality rate, which fell substantially during 1998-2004 (annual percentage change [APC]: - 5.46; 95% confidence interval [CI]: - 6.28 to - 4.64), unexpectedly reversed to a sharp rise after 2020 (APC: 3.91; 95% CI: 2.23 to 5.62). Decomposition analysis identified population aging and demographic growth as the predominant drivers of the increasing burden. Frontier analysis revealed a persistent gap between observed burden and achievable benchmarks. ARIMA models project the burden will remain substantial through 2050, with sustained nonfatal morbidity. China's AF/AFL burden more than doubled from 1990 to 2023, driven by aging and population growth. The post-2020 mortality reversal and persistently high nonfatal burden highlight the urgent need for age- and sex-tailored prevention, early detection, and enhanced chronic care strategies.