CoChat
Sign Up
Cited by 4,506Atrial Fibrillation Management and OutcomesAcute Ischemic Stroke ManagementCardiovascular Health and Risk Factors

Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study

Open access
Chugh, Sumeet S., Havmoeller, Rasmus, Narayanan, Kumar, Singh, David, Rienstra, Michiel, Benjamin, Emelia J., Gillum, Richard F., Kim, Young-Hoon +7 more·2014·Circulation
DOI 10.1161/circulationaha.113.005119PMC PMC4151302
Open this paper in CoChat — free accountOpen PDF

Abstract

Background—: The global burden of atrial fibrillation (AF) is unknown. Methods and Results—: We systematically reviewed population-based studies of AF published from 1980 to 2010 from the 21 Global Burden of Disease regions to estimate global/regional prevalence, incidence, and morbidity and mortality related to AF (DisModMR software). Of 377 potential studies identified, 184 met prespecified eligibility criteria. The estimated number of individuals with AF globally in 2010 was 33.5 million (20.9 million men [95% uncertainty interval (UI), 19.5–22.2 million] and 12.6 million women [95% UI, 12.0–13.7 million]). Burden associated with AF, measured as disability-adjusted life-years, increased by 18.8% (95% UI, 15.8–19.3) in men and 18.9% (95% UI, 15.8–23.5) in women from 1990 to 2010. In 1990, the estimated age-adjusted prevalence rates of AF (per 100 000 population) were 569.5 in men (95% UI, 532.8–612.7) and 359.9 in women (95% UI, 334.7–392.6); the estimated age-adjusted incidence rates were 60.7 per 100 000 person-years in men (95% UI, 49.2–78.5) and 43.8 in women (95% UI, 35.9–55.0). In 2010, the prevalence rates increased to 596.2 (95% UI, 558.4–636.7) in men and 373.1 (95% UI, 347.9–402.2) in women; the incidence rates increased to 77.5 (95% UI, 65.2–95.4) in men and 59.5 (95% UI, 49.9–74.9) in women. Mortality associated with AF was higher in women and increased by 2-fold (95% UI, 2.0–2.2) and 1.9-fold (95% UI, 1.8–2.0) in men and women, respectively, from 1990 to 2010. There was evidence of significant regional heterogeneity in AF estimations and availability of population-based data. Conclusions—: These findings provide evidence of progressive increases in overall burden, incidence, prevalence, and AF-associated mortality between 1990 and 2010, with significant public health implications. Systematic, regional surveillance of AF is required to better direct prevention and treatment strategies.

AI snapshot

Written from the paper’s full text.

TL;DR

This Global Burden of Disease 2010 systematic review estimated that 33.5 million people worldwide had atrial fibrillation (AF) in 2010, with rising prevalence, incidence, DALYs, and AF-associated mortality from 1990 to 2010. The authors conclude that AF is a growing global epidemic requiring systematic surveillance and region-specific prevention and treatment strategies.

Key findings

  • In 2010, an estimated 33.5 million individuals had AF globally: 20.9 million males (95% UI 19.5–22.2 million) and 12.6 million females (95% UI 12.0–13.7 million).
  • Age-adjusted AF prevalence per 100,000 increased from 569.5 in males and 359.9 in females in 1990 to 596.2 and 373.1 in 2010; incidence per 100,000 person-years increased from 60.7 and 43.8 to 77.5 and 59.5, respectively.
  • AF-associated DALYs increased by 18.8% in males (UI 15.8–19.3) and 18.9% in females (UI 15.8–23.5) from 1990 to 2010; mortality increased 2-fold in males (UI 2.0–2.2) and 1.9-fold in females (UI 1.8–2.0), and mortality associated with AF was higher in females overall.
  • Regional variation was substantial: in 2010, the lowest prevalence was in Asia Pacific (340.2 males, 196.0 females per 100,000) and the highest in North America (925.7 males, 520.8 females); incidence was also lowest in Asia Pacific (33.8 males, 19.8 females) and highest in North America (264.5 males, 196.3 females).

Methods

  • Systematic review of population-based AF epidemiological studies published 1980–2010 from the 21 Global Burden of Disease regions, using MEDLINE, EMBASE, and LILACS with no language restrictions; 377 potential studies were identified and 184 met pre-specified eligibility criteria.
  • Prevalence, incidence, mortality, and DALYs were estimated with DisMod-MR, a Bayesian meta-regression tool, and mortality modeling used CODEm/CoDCorrect; rates were age-adjusted and presented per 100,000 persons or person-years with 95% uncertainty intervals.
  • Denominators came from the United Nations population database; AF sequelae were assigned a disability weight of 0.031 for DALY calculations.

Limitations

  • The paper states that AF is heterogeneous and can be asymptomatic, so findings may underestimate burden; differences in surveillance, health care access, routine electrocardiograms, and device assessment may contribute to secular trends.
  • The authors state that observational data cannot accurately estimate the relative importance of contributing factors, publication bias cannot be ruled out, unpublished manuscripts or data were not actively sought, and cause-of-death assignment may be misclassified.
  • The paper also states that low data availability in several regions, geographical disparity in data density, non-representative population bias, and estimates based on imputations mean regional findings should be interpreted with caution, and future trend inferences should be made cautiously.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1161/circulationaha.113.005119

Cites

38 of 38 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 36 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In 1990, the estimated age-adjusted incidence rate of atrial fibrillation was 43.8 per 100,000 person-years in females (95% UI 35.9-55.0).

    “the estimated age-adjusted incidence rates were 60·7/100,000 person-years in males (UI, 49·2–78·5) and 43·8 in females (UI, 35·9–55·0).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Mortality associated with atrial fibrillation increased by 2-fold in males from 1990 to 2010.

    “Mortality associated with AF was higher in females, and increased by 2-fold (UI, 2·0–2·2) and 1·9-fold (UI, 1·8–2·0) in males and females, respectively, from 1990 to 2010.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Burden associated with atrial fibrillation, measured as disability adjusted life-years, increased by 18.8% in males from 1990 to 2010.

    “Burden associated with AF, measured as disability adjusted life-years (DALYs), increased by 18·8% (UI, 15·8–19·3) in males and 18·9% (UI, 15·8–23·5) in females, from 1990 to 2010.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Prevalence rates showed a modest increase between 1990 and 2010 across both sexes.

    “The prevalence rates showed a modest increase between 1990 and 2010 (Figure 3) across both sexes.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Mortality associated with atrial fibrillation was higher in females.

    “Mortality associated with AF was higher in females, and increased by 2-fold (UI, 2·0–2·2) and 1·9-fold (UI, 1·8–2·0) in males and females, respectively, from 1990 to 2010.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 30
  • May combine two claims. 16

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In 2010, the estimated numbers of total deaths represented less than 1% of global mortality in the vast majority of the 21 Global Burden of Disease regions.

    “In 2010, the estimated numbers of total deaths (males and females) represented less than 1% of the global mortality in the vast majority of the 21 GBD regions (Figure 7).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The estimated age-adjusted disability adjusted life-years due to atrial fibrillation were 45.9 per 100,000 in females in 2010.

    “This number increased to 64·5 (UI, 46·8–84·2) and 45·9 (UI, 35·7–58·5) in 2010, representing increases of 18·8% (UI, 15·8–19·3) and 18·9% (UI, 15·8–23·5) for males and females respectively”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The estimated age-adjusted disability adjusted life-years due to atrial fibrillation were 54.3 per 100,000 in males in 1990.

    “The estimated age-adjusted DALYs (per 100,000 population) due to AF were 54·3 (UI, 39·2–72·7) and 38·6 (UI, 28·9–50·5) in 1990 for males and females respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Mortality increased steadily through 1995, 2000 and 2005, especially in the developed world.

    “Mortality increased steadily through 1995, 2000 and 2005 (Figure 5), especially in the developed world.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Mortality associated with atrial fibrillation was higher in females overall; this was mainly driven by comparatively higher mortality in females compared to males in developing countries.

    “Mortality associated with AF was higher in females overall; this was mainly driven by comparatively higher mortality in females (compared to males) in developing countries (Figure 6).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The estimated age-adjusted disability adjusted life-years due to atrial fibrillation were 38.6 per 100,000 in females in 1990.

    “The estimated age-adjusted DALYs (per 100,000 population) due to AF were 54·3 (UI, 39·2–72·7) and 38·6 (UI, 28·9–50·5) in 1990 for males and females respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    The change in atrial fibrillation prevalence from 2005 to 2010 was minimal, especially among males in developed countries as opposed to developing countries.

    “Of interest, the change in AF prevalence from 2005 to 2010 was seen to be minimal, especially among males in the developed countries as opposed to developing countries.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The estimated age-adjusted disability adjusted life-years due to atrial fibrillation were 64.5 per 100,000 in males in 2010.

    “This number increased to 64·5 (UI, 46·8–84·2) and 45·9 (UI, 35·7–58·5) in 2010, representing increases of 18·8% (UI, 15·8–19·3) and 18·9% (UI, 15·8–23·5) for males and females respectively”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Worldwide prevalence and incidence of AF have progressively increased.

    “There have been progressive increases in the worldwide prevalence and incidence of AF”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    There were significant variations in atrial fibrillation burden by Global Burden of Disease region, with developed countries having a greater burden overall.

    “There were significant variations in the AF burden by GBD region, with developed countries having a greater burden overall.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    The absolute disability adjusted life-years related to atrial fibrillation (about 52 per 100,000 overall) is much lower compared to chronic obstructive lung disease (1114 per 100,000), diabetes mellitus (680 per 100,000) and chronic kidney disease (307 per 100,000).

    “Although the absolute DALYs related to AF (about 52 per 100,000 overall) is much lower compared to conditions such as chronic obstructive lung disease (1114 per 100,000), diabetes mellitus (680 per 100,000) and chronic kidney disease (307 per 100,000)20”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Murray CJ Vos T Lozano R Naghavi M Flaxman AD Michaud C Ezzati M Shibuya K Salomon JA Abdalla S Aboyans V Abraham J Ackerman I Aggarwal R Ahn SY Ali MK Alvarado M Anderson HR Anderson LM Andrews KG Atkinson C Baddour LM Bahalim AN Barker-Collo S Barrero LH Bartels DH Basanez MG Baxter A Bell ML Benjamin EJ Bennett D Bernabe E Bhalla K Bhandari B Bikbov B Bin Abdulhak A Birbeck G Black JA Blencowe H Blore JD Blyth F Bolliger I Bonaventure A Boufous S Bourne R Boussinesq M Braithwaite T Brayne C Bridgett L Brooker S Brooks P Brugha TS Bryan-Hancock C Bucello C Buchbinder R Buckle G Budke CM Burc source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The findings provide evidence of progressive increases in overall burden, incidence, prevalence and atrial fibrillation-associated mortality between 1990 and 2010.

    “These findings provide evidence of progressive increases in overall burden, incidence, prevalence and AF-associated mortality between 1990–2010.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Atrial fibrillation is the most common arrhythmia of clinical significance.

    “Atrial fibrillation (AF) is the most common arrhythmia of clinical significance.1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Fuster V Ryden LE Cannom DS Crijns HJ Curtis AB Ellenbogen KA Halperin JL Le Heuzey JY Kay GN Lowe JE Olsson SB Prystowsky EN Tamargo JL Wann S Smith SC Jr Jacobs AK Adams CD Anderson JL Antman EM Hunt SA Nishimura R Ornato JP Page RL Riegel B Priori SG Blanc JJ Budaj A Camm AJ Dean V Deckers JW Despres C Dickstein K Lekakis J McGregor K Metra M Morais J Osterspey A Zamorano JL Acc/aha/esc 2006 guidelines for the management of patients with atrial fibrillation: A report of the american college of cardiology/american heart association task force on practice guidelines and the european society o source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Atrial fibrillation is a growing epidemic.

    “In view of the emergence of AF as a ‘growing epidemic’,15, 17 an assessment of the global burden of AF is warranted.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] Chugh SS Blackshear JL Shen WK Hammill SC Gersh BJ Epidemiology and natural history of atrial fibrillation: Clinical implications J Am Coll Cardiol 2001 37 371 378 11216949 source

      Not checked in the free run.

    • cites [17] Lip GY Kakar P Watson T Atrial fibrillation--the growing epidemic Heart 2007 93 542 543 17435064 PMC1955544 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Of 377 potential studies identified, 184 met pre-specified eligibility criteria.

    “Of 377 potential studies identified, 184 met pre-specified eligibility criteria.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In adjusted models, atrial fibrillation is associated with increased morbidity, especially stroke and heart failure, as well as increased mortality.

    “In adjusted models, AF is associated with increased morbidity, especially stroke and heart failure, as well as increased mortality.2–5”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [2] Kannel WB Wolf PA Benjamin EJ Levy D Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: Population-based estimates Am J Cardiol 1998 82 2N 9N 9809895 source

      Not checked in the free run.

    • cites [3] Benjamin EJ Wolf PA D’Agostino RB Silbershatz H Kannel WB Levy D Impact of atrial fibrillation on the risk of death: The framingham heart study Circulation 1998 98 946 952 9737513 source

      Not checked in the free run.

    • cites [4] Thrall G Lane D Carroll D Lip GY Quality of life in patients with atrial fibrillation: A systematic review Am J Med 2006 119 448 e441 419 16651058 source

      Not checked in the free run.

    • cites [5] Wang TJ Larson MG Levy D Vasan RS Leip EP Wolf PA D’Agostino RB Murabito JM Kannel WB Benjamin EJ Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: The framingham heart study Circulation 2003 107 2920 2925 12771006 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Atrial fibrillation is known to co-exist and interact with other conditions contributing to a worse prognosis than for individuals without atrial fibrillation.

    “AF is known to co-exist and interact with other conditions contributing to a worse prognosis than for individuals without AF.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [29] Mamas MA Caldwell JC Chacko S Garratt CJ Fath-Ordoubadi F Neyses L A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure Eur J Heart Fail 2009 11 676 683 19553398 source

      Not checked in the free run.

    • cites [30] Jabre P Roger VL Murad MH Chamberlain AM Prokop L Adnet F Jouven X Mortality associated with atrial fibrillation in patients with myocardial infarction: A systematic review and meta-analysis Circulation 2011 123 1587 1593 21464054 PMC3082773 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    High blood pressure is the number one risk factor globally, accounting for 7% of all global disability adjusted life-years.

    “Analysis of global risk factors in the GBD 2010 study showed that high blood pressure is the number one risk factor globally (increasing from 4th position in 1990), accounting for 7% of all global DALYs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Lim SS Vos T Flaxman AD Danaei G Shibuya K Adair-Rohani H Amann M Anderson HR Andrews KG Aryee M Atkinson C Bacchus LJ Bahalim AN Balakrishnan K Balmes J Barker-Collo S Baxter A Bell ML Blore JD Blyth F Bonner C Borges G Bourne R Boussinesq M Brauer M Brooks P Bruce NG Brunekreef B Bryan-Hancock C Bucello C Buchbinder R Bull F Burnett RT Byers TE Calabria B Carapetis J Carnahan E Chafe Z Charlson F Chen H Chen JS Cheng AT Child JC Cohen A Colson KE Cowie BC Darby S Darling S Davis A Degenhardt L Dentener F Des Jarlais DC Devries K Dherani M Ding EL Dorsey ER Driscoll T Edmond K Ali SE Engell R source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Temporal trends in atrial fibrillation prevalence may result from lead time bias, increased survival from coexistent cardiovascular conditions, and increased awareness of atrial fibrillation symptoms and clinical diagnosis.

    “Temporal trends in AF prevalence may in addition, result from lead time bias (such that AF cases may be diagnosed earlier in their course), increased survival from coexistent cardiovascular conditions such as ischemic heart disease and heart failure due to improved management of such cardiovascular comorbidities resulting in a larger high-risk group. In addition, increased awareness of AF symptoms”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The exact reasons for the atrial fibrillation trends are unknown but may be partly explained by aging trends in the global population.

    “The exact reasons for these trends are unknown but may be partly explained by aging trends in the global population.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Deaths attributable to hypertension increased by 28.8% from 1990 to 2010.

    “Deaths attributable to hypertension increased by 28.8% from 1990 to 2010, while deaths attributable to obesity increased by 71.7%18.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Lim SS Vos T Flaxman AD Danaei G Shibuya K Adair-Rohani H Amann M Anderson HR Andrews KG Aryee M Atkinson C Bacchus LJ Bahalim AN Balakrishnan K Balmes J Barker-Collo S Baxter A Bell ML Blore JD Blyth F Bonner C Borges G Bourne R Boussinesq M Brauer M Brooks P Bruce NG Brunekreef B Bryan-Hancock C Bucello C Buchbinder R Bull F Burnett RT Byers TE Calabria B Carapetis J Carnahan E Chafe Z Charlson F Chen H Chen JS Cheng AT Child JC Cohen A Colson KE Cowie BC Darby S Darling S Davis A Degenhardt L Dentener F Des Jarlais DC Devries K Dherani M Ding EL Dorsey ER Driscoll T Edmond K Ali SE Engell R source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The systematic review confirms the emergence of atrial fibrillation as a global epidemic, with significant and progressive effects on estimated disability and mortality.

    “Our systematic review of the current worldwide epidemiological data on AF confirms the emergence of this condition as a global epidemic, with significant and progressive effects on estimated disability and mortality.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Atrial fibrillation is known to have a significant impact on health care costs, with the major cost-drivers being hospitalizations, stroke, and loss of productivity.

    “AF is known to have a significant impact on health care costs, with the major cost-drivers being hospitalizations, stroke, and loss of productivity.6, 27, 28”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [6] Stewart S Murphy NF Walker A McGuire A McMurray JJ Cost of an emerging epidemic: An economic analysis of atrial fibrillation in the uk Heart 2004 90 286 292 14966048 PMC1768125 source

      Not checked in the free run.

    • cites [27] Blomstrom Lundqvist C Lip GY Kirchhof P What are the costs of atrial fibrillation? Europace 13 Suppl 2 ii9 12 21518753 source

      Not checked in the free run.

    • cites [28] Bruggenjurgen B Rossnagel K Roll S Andersson FL Selim D Muller-Nordhorn J Nolte CH Jungehulsing GJ Villringer A Willich SN The impact of atrial fibrillation on the cost of stroke: The berlin acute stroke study Value Health 2007 10 137 143 17391422 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In the 1990 Global Burden of Disease study, cardiovascular diseases as a group accounted for 9.7% of global disability adjusted life-years.

    “In the 1990 GBD study, no specific data for AF was reported, but cardiovascular diseases as a group accounted for 9·7% of the global DALYs with ischemic heart disease being the fifth ranking disorder in total number of DALYS (~47x106) behind lower respiratory infections, diarrheal diseases, perinatal disorders, and unipolar major depression.34”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Murray CJ Lopez AD Global mortality, disability, and the contribution of risk factors: Global burden of disease study Lancet 1997 349 1436 1442 9164317 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The rise of cardiovascular disease burden in developing countries possibly indicates an ongoing transition towards non-communicable diseases, earlier associated more with developed nations.

    “The rise of cardiovascular disease burden in developing countries possibly indicates an ongoing transition towards non-communicable diseases, earlier associated more with developed nations.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Assignment of cause of death may be prone to some misclassification.

    “As with any cause of death analysis, assignment of cause of death may be prone to some misclassification.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Atrial fibrillation is a heterogeneous condition, and in a subset of individuals can be asymptomatic.

    “AF is a heterogeneous condition, and in a subset of individuals can be asymptomatic.35, 36”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [35] Furberg CD Psaty BM Manolio TA Gardin JM Smith VE Rautaharju PM Prevalence of atrial fibrillation in elderly subjects (the cardiovascular health study) Am J Cardiol 1994 74 236 241 8037127 source

      Not checked in the free run.

    • cites [36] Blackshear JL Kopecky SL Litin SC Safford RE Hammill SC Management of atrial fibrillation in adults: Prevention of thromboembolism and symptomatic treatment Mayo Clin Proc 1996 71 150 160 8577189 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Regional differences in atrial fibrillation burden do exist, but the study observations may not always be a reliable estimate due to geographical factors.

    “Regional differences in AF burden do exist, but our observations may not always be a reliable estimate, due to geographical”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Due to the low availability of data from several regions, the study findings should be interpreted with caution.

    “Due to the low availability of data from several regions, our findings should be interpreted with caution.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    New-onset atrial fibrillation in heart failure patients might be associated with a particularly poor prognosis.

    “Moreover, new-onset AF in heart failure patients might be associated with a particularly poor prognosis.31, 32”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [31] Swedberg K Olsson LG Charlesworth A Cleland J Hanrath P Komajda M Metra M Torp-Pedersen C Poole-Wilson P Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: Results from comet Eur Heart J 2005 26 1303 1308 15767288 source

      Not checked in the free run.

    • cites [32] Ahmed A Perry GJ Incident atrial fibrillation and mortality in older adults with heart failure Eur J Heart Fail 2005 7 1118 1121 16326363 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    These findings have implications for public health policy and health care costs.

    “findings that have implications for public health policy and health care costs”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Observational data cannot accurately estimate the relative importance of various factors contributing to atrial fibrillation trends.

    “We also acknowledge the inability of observational data to accurately estimate the relative importance of various factors contributing to such trends.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    With the exception of Sub-Saharan Africa and Oceania, cardiovascular disease ranked among the top three causes of disability adjusted life-years in most regions.

    “With the exception of Sub-Saharan Africa and Oceania, cardiovascular disease ranked among the top three causes of DALYs in most regions.20”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Murray CJ Vos T Lozano R Naghavi M Flaxman AD Michaud C Ezzati M Shibuya K Salomon JA Abdalla S Aboyans V Abraham J Ackerman I Aggarwal R Ahn SY Ali MK Alvarado M Anderson HR Anderson LM Andrews KG Atkinson C Baddour LM Bahalim AN Barker-Collo S Barrero LH Bartels DH Basanez MG Baxter A Bell ML Benjamin EJ Bennett D Bernabe E Bhalla K Bhandari B Bikbov B Bin Abdulhak A Birbeck G Black JA Blencowe H Blore JD Blyth F Bolliger I Bonaventure A Boufous S Bourne R Boussinesq M Braithwaite T Brayne C Bridgett L Brooker S Brooks P Brugha TS Bryan-Hancock C Bucello C Buchbinder R Buckle G Budke CM Burc source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In the 1990 Global Burden of Disease study, ischemic heart disease was the fifth ranking disorder in total number of disability adjusted life-years (~47x10^6).

    “In the 1990 GBD study, no specific data for AF was reported, but cardiovascular diseases as a group accounted for 9·7% of the global DALYs with ischemic heart disease being the fifth ranking disorder in total number of DALYS (~47x106) behind lower respiratory infections, diarrheal diseases, perinatal disorders, and unipolar major depression.34”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Murray CJ Lopez AD Global mortality, disability, and the contribution of risk factors: Global burden of disease study Lancet 1997 349 1436 1442 9164317 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In 2010, ischemic heart disease moved up to the number one position.

    “In 2010, ischemic heart disease moved up to the number one position; with cardiovascular disease accounting for 11·8% of global DALYs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Murray CJ Vos T Lozano R Naghavi M Flaxman AD Michaud C Ezzati M Shibuya K Salomon JA Abdalla S Aboyans V Abraham J Ackerman I Aggarwal R Ahn SY Ali MK Alvarado M Anderson HR Anderson LM Andrews KG Atkinson C Baddour LM Bahalim AN Barker-Collo S Barrero LH Bartels DH Basanez MG Baxter A Bell ML Benjamin EJ Bennett D Bernabe E Bhalla K Bhandari B Bikbov B Bin Abdulhak A Birbeck G Black JA Blencowe H Blore JD Blyth F Bolliger I Bonaventure A Boufous S Bourne R Boussinesq M Braithwaite T Brayne C Bridgett L Brooker S Brooks P Brugha TS Bryan-Hancock C Bucello C Buchbinder R Buckle G Budke CM Burc source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Patients with heart failure and myocardial infarction have worse outcomes if they also have atrial fibrillation.

    “For example, recent meta-analyses have shown that patients with heart failure and myocardial infarction have worse outcomes if they also have AF.29, 30”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [29] Mamas MA Caldwell JC Chacko S Garratt CJ Fath-Ordoubadi F Neyses L A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure Eur J Heart Fail 2009 11 676 683 19553398 source

      Not checked in the free run.

    • cites [30] Jabre P Roger VL Murad MH Chamberlain AM Prokop L Adnet F Jouven X Mortality associated with atrial fibrillation in patients with myocardial infarction: A systematic review and meta-analysis Circulation 2011 123 1587 1593 21464054 PMC3082773 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Differences in extent of patient surveillance, including access to health care, use of routine electrocardiograms and assessment of electrical devices such as pacemakers, may be contributing to secular trends in atrial fibrillation.

    “In addition, we note that differences in extent of patient surveillance, including access to health care, use of routine electrocardiograms and assessment of electrical devices such as pacemakers may be contributing to secular trends.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In 2010, cardiovascular disease accounted for 11.8% of global disability adjusted life-years.

    “In 2010, ischemic heart disease moved up to the number one position; with cardiovascular disease accounting for 11·8% of global DALYs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Murray CJ Vos T Lozano R Naghavi M Flaxman AD Michaud C Ezzati M Shibuya K Salomon JA Abdalla S Aboyans V Abraham J Ackerman I Aggarwal R Ahn SY Ali MK Alvarado M Anderson HR Anderson LM Andrews KG Atkinson C Baddour LM Bahalim AN Barker-Collo S Barrero LH Bartels DH Basanez MG Baxter A Bell ML Benjamin EJ Bennett D Bernabe E Bhalla K Bhandari B Bikbov B Bin Abdulhak A Birbeck G Black JA Blencowe H Blore JD Blyth F Bolliger I Bonaventure A Boufous S Bourne R Boussinesq M Braithwaite T Brayne C Bridgett L Brooker S Brooks P Brugha TS Bryan-Hancock C Bucello C Buchbinder R Buckle G Budke CM Burc source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Atrial fibrillation can interact with other diseases in multiple ways, potentially contributing to worse outcomes.

    “as discussed earlier, AF can interact with other diseases in multiple ways, potentially contributing to worse outcomes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A higher degree of European ancestry is associated with an increased predisposition to atrial fibrillation.

    “Furthermore, recent reports indicate that higher degree of European ancestry is associated with an increased predisposition to AF.33”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Marcus GM Alonso A Peralta CA Lettre G Vittinghoff E Lubitz SA Fox ER Levitzky YS Mehra R Kerr KF Deo R Sotoodehnia N Akylbekova M Ellinor PT Paltoo DN Soliman EZ Benjamin EJ Heckbert SR Candidate-Gene Association Resource S European ancestry as a risk factor for atrial fibrillation in african americans Circulation 2010 122 2009 2015 21098467 PMC3058884 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Part of the global variation in atrial fibrillation epidemiology may be attributable to better surveillance in developed countries.

    “However, part of the global variation in AF epidemiology may also be attributable to better surveillance in developed countries.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The study's AF burden observations may not always be a reliable estimate because of geographical disparity of data density, non-representative population bias, and estimates based on imputations.

    “our observations may not always be a reliable estimate, due to geographical disparity of data density and non-representative population bias, as well as estimates based on imputations”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    The study cannot rule out the possible impact of publication bias and did not actively seek out unpublished manuscripts or data.

    “Moreover, we cannot rule out the possible impact of publication-bias and did not actively seek out unpublished manuscripts or data.”
    Quote in the paperNot a substantial claim
43 of 43

  • The paper relies on this without support.

    The global burden of atrial fibrillation is unknown.

    “The global burden of atrial fibrillation (AF) is unknown.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Chugh, S. S., Havmoeller, R., Narayanan, K., Singh, D., Rienstra, M., Benjamin, E. J., Gillum, R. F., Kim, Y.-H., McAnulty, J. H., Zheng, Z.-J., Forouzanfar, M. H., Naghavi, M., Mensah, G. A., Ezzati, M., & Murray, C. J. L.
Affiliations
Boston University (US)
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2014-02-25
Volume
129
Issue
8
Pages
837-847
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.113.005119
PMC
PMC4151302
OpenAlex
W2147018083
Semantic Scholar
8cb0d9ca0de5a91f1f5f4806c85ab40ade8b98b0
Cited by
4,506
References
38
Citations by year
2026: 255 · 2025: 289 · 2024: 370 · 2023: 372 · 2022: 456 · 2021: 546 · 2020: 559 · 2019: 430 · 2018: 418 · 2017: 330 · 2016: 251 · 2015: 154 · 2014: 68 · 2013: 4
FWCI
108.18
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Circulation (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
  • PubMed Central (acceptedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Funders
  • Bill and Melinda Gates Foundation
  • Cedars-Sinai Medical Center
  • Vetenskapsrådet
  • National Institute on Aging (R01AG028321)
  • National Heart, Lung, and Blood Institute (R01HL102214, RC1HL101056, R01HL092577)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords
atrial fibrillation, global burden of disease, prevalence, incidence, mortality, disability-adjusted life years, sex differences, regional variation, cardiovascular disease, population-based study, Global Burden of Disease Study 2010, 1990-2010 trends, women's health, cardiovascular risk factors
MeSH terms
Adult, Aged, Atrial Fibrillation, Female, Humans, Male, Middle Aged, Risk Factors, Global Health, Incidence, Prevalence, Cost of Illness, Age Distribution, Sex Distribution, Quality-Adjusted Life Years

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review