Trends in burden of atrial fibrillation overthree decades: a population-based study

Abstract Background Atrial fibrillation (AF) is the most common sustained arrhythmia, increasing with age. Comprehensive population-based long-term data on AF trends and the associated comorbidities in men and women are scarce. Purpose To assess sex-specific trends in AF prevalence and incidence, as well as the impact of AF-associated comorbidities in three epochs. Methods We used data from a well-defined ongoing population-based cohort. The number of participants of three consecutive cohorts were 7750, 7675, and 7121, spanning three epochs (epoch 1990s: 1989 - 1993, epoch 2000s: 1997 - 2001, and epoch 2010s: 2008 - 2014) , respectively. We estimated the sex-specific AF prevalence and incidence. For AF-associated comorbidities, we calculated the hazards ratio (HR) (95% confidence intervals – CI), using Cox proportional hazard regression models, and the population attributable fractions (PAFs) . Results The mean (standard deviation - SD) age in three epochs were 70.3 (9.6), 70.0 (8.7), and 70.4 (9.8). The 5-year incidence rates for AF in three epochs were 31.4, 22.9, and 44.1 per 1000 person-years for women and 45.0, 34.7, and 65.6 per 1000 person-years for men, respectively. There was no significant trend observed across the three epochs. Hypertension was the only significant comorbidity consistently associated with incident AF over the three epochs; HRs (95% CI) were 2.17 (1.35-3.48) for women and 1.42 (0.94-2.13) for men for epoch 1990s, 1.82 (1.05-3.16) for women and 1.55 (0.93-2.56) for men for epoch 2000s, and 2.95 (1.64-5.30) for women and 1.21 (0.78-1.88) for men for epoch 2010s. Hypertension contributed most to incident AF; PAFs (95% CI) were 46.60 (24.00-68.30), 38.60 (11.90-68.90), and 59.90 (40.50-82.50) in women and 20.70 (-4.54-44.80), 31.70 (11.60-58.90), and 11.90 (-21.80-47.90), in men for the 3 epochs respectively. Conclusion The burden of AF has been increasing during the past three decades in the general population. Despite increasing recognition and management of hypertension, it is still an essential AF-associated comorbidity, especially in women. Tailored hypertension management strategies will insert a favorable impact on AF management. Figure 1