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

In the paper

“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).”

In the paper

“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”

In the paper

“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.”

In the paper

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

In the paper

“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).”

In the paper

“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.”

In the paper

“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.”

In the paper

“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”

In the paper

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

In the paper

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

In the paper

“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”

What the sources say

• Not checked yetcites [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

In the paper

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

In the paper

“Atrial fibrillation (AF) is the most common arrhythmia of clinical significance.1”

What the sources say

• Not checked yetcites [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

In the paper

“In view of the emergence of AF as a ‘growing epidemic’,15, 17 an assessment of the global burden of AF is warranted.”

What the sources say

• Not checked yetcites [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 yetcites [17] Lip GY Kakar P Watson T Atrial fibrillation--the growing epidemic Heart 2007 93 542 543 17435064 PMC1955544 source

In the paper

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

In the paper

“In adjusted models, AF is associated with increased morbidity, especially stroke and heart failure, as well as increased mortality.2–5”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [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

In the paper

“AF is known to co-exist and interact with other conditions contributing to a worse prognosis than for individuals without AF.”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“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.”

What the sources say

• Not checked yetcites [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

In the paper

“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”

In the paper

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

In the paper

“Deaths attributable to hypertension increased by 28.8% from 1990 to 2010, while deaths attributable to obesity increased by 71.7%18.”

What the sources say

• Not checked yetcites [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

In the paper

“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.”

In the paper

“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”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [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

In the paper

“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”

What the sources say

• Not checked yetcites [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

In the paper

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

In the paper

“As with any cause of death analysis, assignment of cause of death may be prone to some misclassification.”

In the paper

“AF is a heterogeneous condition, and in a subset of individuals can be asymptomatic.35, 36”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

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

In the paper

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

In the paper

“Moreover, new-onset AF in heart failure patients might be associated with a particularly poor prognosis.31, 32”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“findings that have implications for public health policy and health care costs”

In the paper

“We also acknowledge the inability of observational data to accurately estimate the relative importance of various factors contributing to such trends.”

In the paper

“With the exception of Sub-Saharan Africa and Oceania, cardiovascular disease ranked among the top three causes of DALYs in most regions.20”

What the sources say

• Not checked yetcites [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

In the paper

“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”

What the sources say

• Not checked yetcites [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

In the paper

“In 2010, ischemic heart disease moved up to the number one position; with cardiovascular disease accounting for 11·8% of global DALYs.”

What the sources say

• Not checked yetcites [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

In the paper

“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”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“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.”

In the paper

“In 2010, ischemic heart disease moved up to the number one position; with cardiovascular disease accounting for 11·8% of global DALYs.”

What the sources say

• Not checked yetcites [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

In the paper

“as discussed earlier, AF can interact with other diseases in multiple ways, potentially contributing to worse outcomes.”

In the paper

“Furthermore, recent reports indicate that higher degree of European ancestry is associated with an increased predisposition to AF.33”

What the sources say

• Not checked yetcites [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

In the paper

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

In the paper

“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”

In the paper

“Moreover, we cannot rule out the possible impact of publication-bias and did not actively seek out unpublished manuscripts or data.”