Global Burden of Atrial Fibrillation and Its Attributable Risk Factors (1990-2021)

Objectives: To report the global burden of atrial fibrillation (AF) and its risk factors among adults from 1990 to 2021, with a focus on age-specific trends, sex disparities, and the role of modifiable risk factors, particularly in older adults. Design: A systematic analysis based on data from the Global Burden of Disease (GBD) 2021 study. Outcome Measures: The point prevalence of AF, mortality, and disability-adjusted life years (DALYs) were reported from the GBD 2021 study, presented as counts and age-standardized rates per 100,000 population, along with 95% uncertainty intervals (UIs). Results: In 2021, the global age-standardized prevalence of AF was 620.5 per 100,000, with corresponding mortality and DALY rates of 4.4 and 101.4 per 100,000, respectively. The highest prevalence rates were observed in Sweden (1,529.8 per 100,000), Austria (1,217.2 per 100,000), and Israel (1,155.5 per 100,000), while the lowest were recorded in Turkey (282.9 per 100,000), Yemen (337.2 per 100,000), and Afghanistan (338.8 per 100,000). Between 1990 and 2021, the most significant increases in prevalence were noted in Austria (89.3%), whereas the largest decreases occurred in Romania (-27.4%). The prevalence of AF rose markedly with age, peaking among individuals aged 95 years and older, with males generally exhibiting higher rates than females. Globally, high systolic blood pressure (30%), high body mass index (8.7%), and smoking (4.7%) were the leading risk factors for AF. Conclusions: AF represents a growing global public health challenge, particularly in low- and middle-income countries, primarily driven by hypertension and obesity. Targeted interventions focusing on modifiable risk factors are essential to reduce the global burden of AF.