Heartbeat: the global burden of atrial fibrillation and ensuring anticoagulation persistence

Atrial fibrillation (AF) is the most common sustained arrhythmia, with an increasing worldwide prevalence related to a progressively ageing population. Most of the worldwide AF burden is concentrated in low-income and middle-income countries, with scanty information about local prevalence rates and determinants of AF burden. In this issue of Heart , Du et al 1 report a community-based survey of 47 841 adults (age ≥45 years) conducted in seven geographic regions of China between 2014 and 2016. The weighted AF prevalence, defined by either ECG detection or self-report, was estimated to be 1.8% (95% CI 1.7% to 1.9%) after accounting for sampling weights, non-response, and age and sex distribution of the population. However, AF prevalence varied from 0.9% to 2.4% across geographical regions, with an estimated total number of people in AF in excess of 7.9 (95% CI 7.4 to 8.4) million, which is higher than previously reported in China. Patient awareness of AF was low (35.8%), with lower levels of awareness associated with older age, male sex, rural residency, lower education level and lack of a stable occupation. Large treatment gaps were observed: among the adults with non-valvular AF and high CHA2DS2-VASc scores (≥2 men or ≥3 women),oral anticoagulation (OAC) therapy was used in only 6.0%. …