Lifetime Risk for Development of Atrial Fibrillation: The Framingham Heart Study
Abstract
Background— Atrial fibrillation (AF) is the most common cardiac dysrhythmia and a source of considerable morbidity and mortality, but lifetime risk for AF has not been estimated. Methods and Results— We included all participants in the Framingham Heart Study who were free of AF at index ages of 40 years and older. We estimated lifetime risks for AF (including atrial flutter) to age 95 years, with death free of AF as a competing event. We followed 3999 men and 4726 women from 1968 to 1999 (176 166 person-years); 936 participants had development of AF and 2621 died without prior AF. At age 40 years, lifetime risks for AF were 26.0% (95% CI, 24.0% to 27.0%) for men and 23.0% (21.0% to 24.0%) for women. Lifetime risks did not change substantially with increasing index age despite decreasing remaining years of life because AF incidence rose rapidly with advancing age. At age 80 years, lifetime risks for AF were 22.7% (20.1% to 24.1%) in men and 21.6% (19.3% to 22.7%) in women. In further analyses, counting only those who had development of AF without prior or concurrent congestive heart failure or myocardial infarction, lifetime risks for AF were approximately 16%. Conclusions— Lifetime risks for development of AF are 1 in 4 for men and women 40 years of age and older. Lifetime risks for AF are high (1 in 6), even in the absence of antecedent congestive heart failure or myocardial infarction. These substantial lifetime risks underscore the major public health burden posed by AF and the need for further investigation into predisposing conditions, preventive strategies, and more effective therapies.
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Several regional studies suggest rising prevalence and incidence of atrial fibrillation.
“Several regional studies suggest rising prevalence and incidence of AF.9–13”
From Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study (2014) · cites this paper as [9]
In North American populations, despite higher incidence of AF in men, lifetime risk of AF in women and men is similar owing to longer life expectancy for women.
“In North American populations, despite higher incidence of AF in men, lifetime risk of AF in women and men were similar owing to longer life expectancy for women.”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [30]
In the Rotterdam Study, the lifetime risks for women and men at age 55 years were 22.2% and 23.8%, respectively.
“In the Rotterdam Study, the lifetime risks for women and men at age 55 years were 22.2% and 23.8%, respectively.30”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [30]
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- Authors
- Lloyd-Jones, D. M., Wang, T. J., Leip, E. P., Larson, M. G., Levy, D., Vasan, R. S., D’Agostino, R. B., Massaro, J. M., Beiser, A., Wolf, P. A., & Benjamin, E. J.
- Affiliations
- From the Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill (D.M.L.-J.); the National Heart, Lung, and Blood Institute’s Framingham Heart Study, National Institutes of Health, Framingham, Mass (all authors); the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (T.J.W.); the Department of Epidemiology and Preventive Medicine (M.G.L., D.L., R.B.D., R.S.V., E.J.B.), Cardiology Department (R.S.V., E.J.B.), and...
- Northwestern University (US)
- Boston University (US)
- ORCID
- Venue
- Circulation
- Published
- 2004-08-31
- Volume
- 110
- Issue
- 9
- Pages
- 1042-1046
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2137434301
- Cited by
- 2,041
- References
- 41
- Citations by year
- 2026: 43 · 2025: 53 · 2024: 71 · 2023: 71 · 2022: 84 · 2021: 102 · 2020: 111 · 2019: 101 · 2018: 124 · 2017: 136 · 2016: 119 · 2015: 130 · 2014: 129 · 2013: 170 · 2012: 145
- FWCI
- 28.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc25195-41-0-1)
- National Heart, Lung, and Blood Institute (K23 HL04253, N01‐HC25195, K23HL004253)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- atrial fibrillation, lifetime risk, atrial flutter, Framingham Heart Study, competing risks, congestive heart failure, myocardial infarction, sex differences, public health burden, cardiac arrhythmias
- MeSH terms
- Adult, Age Factors, Aged, Aged, 80 and over, Atrial Fibrillation, Atrial Flutter, Electrocardiography, Female, Follow-Up Studies, Heart Failure, Humans, Hypertension, Male, Middle Aged, Myocardial Infarction, Risk, Risk Factors, United States, Cohort Studies, Incidence
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