Global, regional, and national burden and trends of atrial fibrillation and flutter among individuals aged 55 and older from 1990 to 2021: results from the 2021 global burden of disease study

The rising prevalence of atrial fibrillation and flutter (AF/AFL) in individuals aged 55 and older presents a major public health challenge. However, a systematic analysis of the long-term global burden and trends exclusively within this high-risk demographic is lacking. Data from the 2021 Global Burden of Disease (GBD 2021) study were used to analyze AF/AFL burden in this older population. We analyzed trends in prevalence, incidence, deaths, and disability-adjusted life years (DALYs). To assess temporal trends independent of demographic changes, the Estimated Annual Percentage Change (EAPC) was calculated by fitting a log-linear model to the age-standardized rates. Regional and sex-specific differences were compared across five Socio-Demographic Index (SDI) regions. Globally, from 1990 to 2021, the absolute number of individuals with AF/AFL increased from 19.91 million to 47.86 million, and DALYs rose from 3.08 million to 7.80 million. In contrast, the global age-standardized incidence rate remained relatively stable. The burden increased most rapidly in low-to-middle SDI regions, whereas high-SDI regions showed stabilization in rates. While females experienced a higher absolute burden in DALYs and deaths, males exhibited faster increases in age-standardized rates. The largest prevalence increase was observed in individuals aged 95 and older. Our trend-oriented analysis indicates that global burden of AF/AFL in individuals aged 55 and older has markedly increased. This presents a dual challenge for health systems. Targeted, resource-appropriate prevention and management strategies tailored to specific age, sex, and socioeconomic contexts are urgently needed to address this growing global health concern.