Epidemiology

AF is the most common sustained cardiac arrhythmia in adults worldwide.[1]

Prevalence is thought to be 2% to 4%.[1] Estimates suggest that prevalence is increasing, owing in part to extended longevity in the general population and ongoing efforts to search for undiagnosed AF.[1][3] 

If left untreated, AF is a significant risk factor for stroke, other morbidities, and mortality.[1] Men are more commonly affected than women and the prevalence increases with age.[1][3][4][5] 

Lifetime risk is estimated to be 1 in 3 individuals of European ancestry at index age of 55 years.[1][4][5]

Risk factors

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increasing age

Significantly associated with risk of AF.[13][14] Prevalence of AF: 0.5% in people aged 50 to 59 years; 8.8% in people aged 80 to 89 years.[15]

hypertension

The most common aetiological factor associated with the development of AF.[1] Patients with hypertension have a 1.7-fold higher risk of developing AF compared with normotensive patients.[1] 

heart failure

Approximately 40% of patients admitted with heart failure and reduced ejection fraction and 50% of patients admitted with heart failure and preserved ejection fraction have AF on ECG.[16]

diabetes mellitus

Associated with a 50% increase in risk of AF.[13]

obstructive sleep apnoea

Prevalence among people with AF estimated at 50% or higher.[17][18]

obesity

Associated with a 50% increase in the risk of AF.[19] Obese people may have more left ventricular diastolic dysfunction, sympathetic activity and inflammation, and atrial fatty infiltration.[20]

coronary artery disease

Prevalence in AF is 41%.[21]

valve disease

In particular, mitral valve disease and rheumatic heart disease.

other cardiac disease

May be associated with valvular or congenital cardiac disease, or cardiomyopathy.[22]

regular, heavy alcohol consumption

Regular light‐moderate alcohol consumption (<14 units/week) without binge drinking is not associated with an increased risk of AF.[23] However, regular heavier alcohol consumption (>14 units/week) is associated with an increased risk of AF.[23] Binge drinking is a known trigger for AF.[24][25]  

cardiac or thoracic surgery

Common postoperative complication.[20]

other atrial arrhythmias

May be associated with atrial flutter, Wolff-Parkinson-White syndrome, or atrioventricular nodal re-entrant tachycardias.[20]

previous stroke/transient ischaemic attack

Associated with risk of AF.[1]

hyperthyroidism

About 10% to 15% of patients with untreated thyrotoxicosis develop AF.[26]

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athletic levels of physical activity

Limited data suggest that athletes may have a higher risk of developing AF.[27]

COPD

Associated with risk of AF.[1]

smoking

May be associated with AF. One meta-analysis of prospective cohort studies found that the risk was higher in male smokers compared with female smokers.[28]

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