AF is the most common sustained cardiac arrhythmia worldwide.[1]Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2024 Jan 2;149(1):e1-156.
https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001193
http://www.ncbi.nlm.nih.gov/pubmed/38033089?tool=bestpractice.com
The Global Burden of Disease 2017 study found the prevalence of AF to be 481.5 per 100,000 person-years, affecting 19.8 million men and 17.8 million women worldwide.[4]Wang L, Ze F, Li J, et al. Trends of global burden of atrial fibrillation/flutter from Global Burden of Disease Study 2017. Heart. 2021 Jun;107(11):881-7.
https://heart.bmj.com/content/107/11/881
http://www.ncbi.nlm.nih.gov/pubmed/33148545?tool=bestpractice.com
The estimated global prevalence was 50 million in 2020.[1]Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2024 Jan 2;149(1):e1-156.
https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001193
http://www.ncbi.nlm.nih.gov/pubmed/38033089?tool=bestpractice.com
However, the true prevalence is difficult to ascertain. Both incidence and prevalence rates are higher in older people, and in developed countries, with the highest prevalence in high-income North America.[4]Wang L, Ze F, Li J, et al. Trends of global burden of atrial fibrillation/flutter from Global Burden of Disease Study 2017. Heart. 2021 Jun;107(11):881-7.
https://heart.bmj.com/content/107/11/881
http://www.ncbi.nlm.nih.gov/pubmed/33148545?tool=bestpractice.com
[5]Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 study. Circulation. 2014 Feb 25;129(8):837-47.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151302
http://www.ncbi.nlm.nih.gov/pubmed/24345399?tool=bestpractice.com
While the age-adjusted incidence and prevalence of AF are lower in women than in men, mortality risk due to AF is similar or higher in women compared with men.[2]Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021 Feb 1;42(5):373-498.
https://academic.oup.com/eurheartj/article/42/5/373/5899003?login=false
Women with AF may be more symptomatic, older, and/or have more comorbidities than men.[5]Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 study. Circulation. 2014 Feb 25;129(8):837-47.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151302
http://www.ncbi.nlm.nih.gov/pubmed/24345399?tool=bestpractice.com
Epidemiologic data on new-onset AF are limited. Extrapolation from the Framingham study indicates the incidence of new-onset AF in middle-aged (age 55 years) women and men to be 0.2% and 0.3%, respectively.[6]Lip GYH, Apostolakis S. Atrial fibrillation (acute onset). BMJ Clin Evid. 2014 Nov 27;2014.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4246362
http://www.ncbi.nlm.nih.gov/pubmed/25430048?tool=bestpractice.com
In patients with a first-ever ischemic stroke, there is a high prevalence (15% to 25%) of AF, and the incidence of AF is around 5%.[7]Marini C, De Santis F, Sacco S, et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke, results from a population-based study. Stroke. 2005 Jun;36(6):1115-9.
https://www.ahajournals.org/doi/full/10.1161/01.STR.0000166053.83476.4a?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
http://www.ncbi.nlm.nih.gov/pubmed/15879330?tool=bestpractice.com
[8]Paciaroni M, Agnelli G, Caso V, et al. Atrial fibrillation in patients with first-ever stroke: frequency, antithrombotic treatment before the event and effect on clinical outcome. J Thromb Haemost. 2005 Jun;3(6):1218-23.
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1538-7836.2005.01344.x
http://www.ncbi.nlm.nih.gov/pubmed/15892862?tool=bestpractice.com
Studies assessing prolonged ECG monitoring (using a 30-day event-triggered recorder, or an insertable cardiac monitoring device) in patients with cryptogenic stroke have found AF to be common in these patients.[9]Gladstone DJ, Spring M, Dorian P, et al. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med. 2014 Jun 26;370(26):2467-77.
http://www.nejm.org/doi/full/10.1056/NEJMoa1311376#t=article
http://www.ncbi.nlm.nih.gov/pubmed/24963566?tool=bestpractice.com
[10]Sanna T, Diener HC, Passman RS, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. 2014 Jun 26;370(26):2478-86.
http://www.nejm.org/doi/full/10.1056/NEJMoa1313600#t=article
http://www.ncbi.nlm.nih.gov/pubmed/24963567?tool=bestpractice.com
[11]Katsanos AH, Kamel H, Healey JS, et al. Stroke prevention in atrial fibrillation: looking forward. Circulation. 2020 Dec 15;142(24):2371-88.
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049768
http://www.ncbi.nlm.nih.gov/pubmed/33315494?tool=bestpractice.com
New-onset AF occurs in approximately 10% of patients after acute myocardial infarction and in 20% of patients with heart failure, and independently predicts a worse short- and long-term prognosis among patients with these conditions.[12]Wong CK, White HD, Wilcox RG, et al. New atrial fibrillation after acute myocardial infarction independently predicts death: the GUSTO-III experience. Am Heart J. 2000 Dec;140(6):878-85.
http://www.ncbi.nlm.nih.gov/pubmed/11099991?tool=bestpractice.com
[13]Asanin M, Perunicic J, Mrdovic I, et al. Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial infarction. Eur J Heart Fail. 2005 Jun;7(4):671-6.
https://onlinelibrary.wiley.com/doi/full/10.1016/j.ejheart.2004.07.018
http://www.ncbi.nlm.nih.gov/pubmed/15921810?tool=bestpractice.com
[14]Mentz RJ, Chung MJ, Gheorghiade M, et al. Atrial fibrillation or flutter on initial electrocardiogram is associated with worse outcomes in patients admitted for worsening heart failure with reduced ejection fraction: findings from the EVEREST Trial. Am Heart J. 2012 Dec;164(6):884-92;e2.
http://www.ncbi.nlm.nih.gov/pubmed/23194489?tool=bestpractice.com
[15]Gorenek B, Halvorsen S, Kudaiberdieva G, et al. Atrial fibrillation in acute heart failure: A position statement from the Acute Cardiovascular Care Association and European Heart Rhythm Association of the European Society of Cardiology. Eur Heart J Acute Cardiovasc Care. 2020 Jun;9(4):348-57.
https://academic.oup.com/ehjacc/article/9/4/348/5950241
http://www.ncbi.nlm.nih.gov/pubmed/31976747?tool=bestpractice.com
[16]He J, Yang Y, Zhang G, et al. Clinical risk factors for new-onset atrial fibrillation in acute myocardial infarction: A systematic review and meta-analysis. Medicine (Baltimore). 2019 Jun;98(26):e15960.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6616519
http://www.ncbi.nlm.nih.gov/pubmed/31261502?tool=bestpractice.com