Global epidemiology of atrial fibrillation and atrial flutter: an increasing worldwide burden
Fabian Sanchis-Gomar, Carl J Lavie, Giuseppe LippiBackground:
Atrial fibrillation and atrial flutter (AF/AFL) are major contributors to ischemic stroke, heart failure, disability, and mortality worldwide.
Objective:
To provide a descriptive global analysis of AF/AFL burden using GBD 2023 estimates, with emphasis on incidence, prevalence, deaths, disability-adjusted life years (DALYs), and their distribution by sex, age, and socio-demographic index (SDI).
Methods:
We performed a descriptive epidemiological analysis using direct extractions from the Institute for Health Metrics and Evaluation Global Burden of Disease 2023 Results Tool for the cause category “atrial fibrillation and atrial flutter.” We assessed incidence, prevalence, deaths, DALYs, and selected rates globally and according to sex, quinquennial age group, and SDI. Temporal trends were examined using available historical series, and the 2023 burden was summarized across major demographic and SDI strata.
Results:
In 2023, AF/AFL accounted globally for 5,021,980 incident cases, 59,045,058 prevalent cases, 9,265,726 DALYs, and 377,258 deaths. Compared with 1990, the global burden increased substantially in absolute terms. It was substantially higher in older adults, with the highest observed counts of incident and prevalent cases in the 70–74-year age group, the highest DALY counts in the 80–84-year age group, and the highest death counts in the 85–89-year age group. Men accounted for more incident and prevalent cases in absolute terms, whereas women accounted for more deaths and DALYs; age-standardized rates indicated higher male incidence, prevalence, and DALYs, but essentially equivalent mortality between sexes. High-SDI settings carried the largest absolute burden and the highest rates across all major metrics. Overall, the findings indicate a marked expansion in the global AF/AFL burden, with important heterogeneity by age, sex, and socio-demographic development.
Conclusions:
AF/AFL remains a major and growing global public health challenge. The burden is increasingly concentrated in older populations, shows persistent sex differences, and remains greater in high-SDI settings. These findings reinforce the relevance of AF/AFL to stroke prevention, health system planning, and long-term cardiovascular care worldwide.