What is the epidemiology of atrial fibrillation?

Epidemiology of Atrial Fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting approximately 1-2% of the general population, with prevalence increasing dramatically with age from <0.5% at age 40-50 years to 5-15% at age 80 years. 1

Prevalence and Demographics

• The estimated prevalence of AF is 0.4% to 1% in the general population, increasing with age 1
• Cross-sectional studies show prevalence increasing from very low levels below age 60 to approximately 8% in those older than 80 years 1
• In the United States, approximately 10.55 million adults have atrial fibrillation 2
• In North America, an estimated 2.3 million people have paroxysmal or persistent AF, while this number reaches 4.5 million in the European Union 1
• The median age of AF patients is about 75 years, with approximately 70% between 65 and 85 years old 1
• The lifetime risk of developing AF is 25% in those who have reached the age of 40 1

Gender and Racial Differences

• The age-adjusted prevalence of AF is higher in men than in women 1
• The prevalence in men has more than doubled from the 1970s to the 1990s, while prevalence in women has remained relatively unchanged 1
• Overall, the number of men and women with AF is about equal, but approximately 60% of AF patients over 75 years are female 1
• Based on limited data, the age-adjusted risk of developing AF in blacks appears to be less than half that in whites 1
• AF is less common among African-American than Caucasian patients with heart failure 1

Trends and Projections

• During the past 20 years, there has been a 66% increase in hospital admissions for AF 1
• The incidence of AF appears to be increasing (13% in the past two decades) 1
• It is projected that the number of patients with AF in the United States will increase to more than 5.6 million by the year 2050, with more than 50% of affected individuals aged 80 years or older 3

Associated Conditions

• In population-based studies, patients with no history of cardiopulmonary disease (lone AF) account for fewer than 12% of all cases of AF 1
• In the Euro Heart Survey on AF, the prevalence of idiopathic AF was approximately 10%, with higher rates in paroxysmal AF (15%) than in permanent AF (4%) 1
• The most prominent conditions associated with AF include:
  • Essential hypertension (39% of patients) 1
  • Congestive heart failure (30% of patients) 1
  • Hypertensive heart disease (21% of patients) 1
  • Coronary artery disease (17% of patients) 1
  • Valvular heart disease (15% of patients) 1
  • Diabetes (11% of patients) 1

Economic Impact

• AF is an extremely costly public health problem, with hospitalizations as the primary cost driver (52%), followed by drugs (23%), consultations (9%), further investigations (8%), loss of work (6%), and paramedical procedures (2%) 1
• The annual cost per patient is approximately €3000 (approximately U.S. $3600) 1
• The total societal burden is estimated at about €13.5 billion (approximately U.S. $15.7 billion) in the European Union 1

Clinical Outcomes and Mortality

• AF is associated with significantly increased risk of stroke, heart failure, myocardial infarction, dementia, chronic kidney disease, and mortality 2
• The mortality rate of patients with AF is about double that of patients in normal sinus rhythm 1
• AF-related strokes are often more severe, with higher rates of mortality and disability compared to non-AF strokes 1
• Approximately 20% of all strokes are attributed to AF 1
• The combination of AF and heart failure synergistically increases mortality risk compared to either condition alone 4

Asymptomatic and Subclinical AF

• Approximately 10% to 40% of people with AF are asymptomatic 2
• Subclinical or device-detected AF is increasingly recognized through cardiac implantable electronic devices, presenting new challenges for management 5
• Cognitive decline or stroke may be the first manifestation of previously undiagnosed atrial fibrillation 5