Global, regional, and national burden of atrial fibrillation and atrial flutter in the working-age population from 1990 to 2021: A systematic analysis based on 2021 global burden of disease data

Atrial fibrillation and atrial flutter impose a significant global health burden, particularly among individuals aged 30-64 years. This study analyzed data from the Global Burden of Disease 2021 database to estimate disease burden trends from 1990 to 2021. Key metrics included age-standardized incidence, prevalence, mortality, and disability-adjusted life years rates, stratified by age, sex, and Socio-Demographic Index. The methodologies encompassed descriptive analysis, age-period-cohort modeling, decomposition techniques, and Bayesian forecasting. From 1990 to 2021, age-standardized incidence rates increased by an estimated annual percentage change of 0.14, prevalence rates by 0.20, and disability rates by 0.08, while mortality rates declined by 0.16. By 2021, global incidence reached 47.05 per 100,000 population, prevalence 397.94, mortality 0.49, and disability 48.46. High-SDI regions exhibited the highest burden, with incidence at 61.01 and prevalence at 515.73 per 100,000, whereas low-SDI regions recorded the lowest incidence and prevalence at 35.32 and 282.73, respectively. Males consistently showed higher incidence, prevalence, and disability rates than females, with disease burden peaking in the 60-64 age group. Population growth contributed 52 % to the rise in prevalent cases, surpassing aging and epidemiological factors. Projections to 2050 indicate declines in incidence to 45.18 and prevalence to 387.53 per 100,000, but mortality and disability rates are expected to rise to 0.51 and 49.29. High systolic blood pressure accounted for 13.04 % of disability-adjusted life years globally, with contributions from high body mass index increasing across all SDI quintiles. Health inequalities narrowed between high- and low-SDI countries, with the slope index of inequality decreasing from 21.41 to 15.41 per 100,000 years and the concentration index shifting from 0.04 to -0.02. Critical priorities include optimising screening programmes in high-SDI regions, expanding access to hypertension control and anticoagulant therapy in low-SDI areas, and implementing reasonable monitoring of consumption of highly processed foods high in salt and sugar. Multisectoral strategies integrating real-time burden monitoring, salt-sugar regulation policies, and equitable technology distribution are essential to align with Sustainable Development Goals. This study underscores the necessity of region-specific interventions to mitigate economic productivity losses linked to atrial fibrillation and atrial flutter in the working-age population.