Burden and age-specific trends of atrial fibrillation/atrial flutter from 1990 to 2023: A growing challenge among younger and middle-aged adults

Abstract Background The burden of atrial fibrillation and atrial flutter (AF/AFL) has increased, but age-specific patterns across World Bank income levels (WBILs) remain unclear. Methods Using the Global Burden of Disease 2023 estimates, we assessed age- and WBIL-stratified trends in prevalence, incidence, mortality, and disability-adjusted life years (DALYs) for AF/AFL from 1990 to 2023, employing age–period–cohort analysis and joinpoint regression. Mortality attributable to six modifiable risk factors was quantified based on comparative risk assessment estimates. Projections of AF/AFL burden for 2024–2048 were generated using Bayesian age–period–cohort models. Results In 2023, AF/AFL affected 58.99 million prevalent cases, 5.02 million incident cases, 376862 deaths, and 9.26 million DALYs, with the absolute burden concentrated in adults aged ≥ 65 years. From 1990 to 2023, age-standardized prevalence (ASPR) and incidence rate (ASIR) increased, while mortality rate (ASMR) and disability-adjusted life year rate (ASDR) remained stable. High-income countries showed increases across all metrics, upper-middle-income countries had rising ASPR/ASIR and decreasing ASMR/ASDR, and lower-middle- and low-income countries showed consistent increases across all metrics. Among younger (30–44 years) and middle-aged (45–64 years) adults, all metrics increased, while in older adults, only ASPR rose. High systolic blood pressure was the leading attributable risk factor, with larger contributions from high body mass index, smoking, and alcohol use in younger and middle-aged adults. Projections indicated modest declines in ASPR, stable ASIR, and increasing ASMR/ASDR through 2048. Conclusions Despite the concentrated burden in older adults, mortality- and disability-related burden is rising in younger and middle-aged populations, with significant variation across WBILs.