Atrial fibrillation epidemiology and demographics: Difference between revisions

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| [[File:Siren.gif|30px|link=Atrial fibrillation resident survival guide]]|| <br> || <br>
| [[Atrial fibrillation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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| [[File:Critical_pathways_.gif|88px|link=Atrial fibrillation critical pathways]]|| <br> || <br>
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| <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|75px]]
| <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|100px]]
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{{Template:Atrial fibrillation}}
{{Template:Atrial fibrillation}}
{{CMG}}
{{CMG}} {{AE}} {{Anahita}}


'''Associate Editor-In-Chief:''' {{CZ}}
==Overview==
[[Incidence]] of [[atrial fibrillation]] is approximately less than 0.1% per year in those under 40 years of age. On the other hand [[incidence]] rate increases to greater than 1.5% per year in [[female|women]] over 80 age and greater than 2% per year in [[male|men]] over 80 years of age. The [[atrial fibrillation]] [[prevalence]] in the general population is 0.4%. [[Prevalence]] of [[atrial fibrillation]] has been estimated to be even more, since many cases of [[atrial fibrillation]] remain [[symptom|asymptomatic]] for a long time. [[Atrial fibrillation]] is associated with a 1.5 to 1.9 fold increase in the risk of death. The [[incidence]] of [[atrial fibrillation]] increases with [[Ageing|age]] ([[median]] age of 75 years). [[Prevalence]] of [[atrial fibrillation]] has been reported to be higher among Caucasians (European ancestry) and it is more common in [[males]] compared to [[females]].


'''Synonyms and related keywords''': AF, Afib, fib
==Epidemiology and Demographics==
===Incidence===
*Researches have shown that the [[incidence]] of [[atrial fibrillation]] is approximately less than 0.1% per year in those under 40 years of age. On the other hand [[incidence]] rate increases to greater than 1.5% per year in [[female|women]] over 80 age and greater than 2% per year in [[male|men]] over 80 years of age. <ref name="pmid16908781">{{Cite pmid|16908781}}</ref>
*Based on another study the [[incidence]] of [[atrial fibrillation]] among the US Medicare beneficiaries older than 65 years old has been reported 28.3 per 1,000 person annually.<ref name="pmid22235070">{{cite journal| author=Piccini JP, Hammill BG, Sinner MF, Jensen PN, Hernandez AF, Heckbert SR | display-authors=etal| title=Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993-2007. | journal=Circ Cardiovasc Qual Outcomes | year= 2012 | volume= 5 | issue= 1 | pages= 85-93 | pmid=22235070 | doi=10.1161/CIRCOUTCOMES.111.962688 | pmc=3332107 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22235070  }} </ref><ref name="pmid24966695">{{cite journal| author=Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S| title=Epidemiology of atrial fibrillation: European perspective. | journal=Clin Epidemiol | year= 2014 | volume= 6 | issue=  | pages= 213-20 | pmid=24966695 | doi=10.2147/CLEP.S47385 | pmc=4064952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24966695  }} </ref>
*Other studies demonstrated on European population released the following information regard the [[incidence]] of [[atrial fibrillation]]:<ref name="pmid24966695">{{cite journal| author=Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S| title=Epidemiology of atrial fibrillation: European perspective. | journal=Clin Epidemiol | year= 2014 | volume= 6 | issue=  | pages= 213-20 | pmid=24966695 | doi=10.2147/CLEP.S47385 | pmc=4064952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24966695  }} </ref><ref name="pmid17277353">{{cite journal| author=Murphy NF, Simpson CR, Jhund PS, Stewart S, Kirkpatrick M, Chalmers J | display-authors=etal| title=A national survey of the prevalence, incidence, primary care burden and treatment of atrial fibrillation in Scotland. | journal=Heart | year= 2007 | volume= 93 | issue= 5 | pages= 606-12 | pmid=17277353 | doi=10.1136/hrt.2006.107573 | pmc=1955558 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17277353  }} </ref><ref name="pmid23220354">{{cite journal| author=Wilke T, Groth A, Mueller S, Pfannkuche M, Verheyen F, Linder R | display-authors=etal| title=Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients. | journal=Europace | year= 2013 | volume= 15 | issue= 4 | pages= 486-93 | pmid=23220354 | doi=10.1093/europace/eus333 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23220354  }} </ref>
**The [[incidence]] of [[atrial fibrillation]] has been estimated as 0.23 per 1,000 person/years in Iceland.
**The [[incidence]] of [[atrial fibrillation]] has been estimated as 0.41 per 1,000 person/years in Germany.
**The [[incidence]] of [[atrial fibrillation]] has been estimated as 0.9 per 1,000 person/years in Scotland.


==Epidemiology==
===Prevalence===
*The [[prevalence]] in the general population is 0.4%.<ref name="pmid14297523">{{cite journal |author=OSTRANDER LD, BRANDT RL, KJELSBERG MO, EPSTEIN FH |title=ELECTROCARDIOGRAPHIC FINDINGS AMONG THE ADULT POPULATION OF A TOTAL NATURAL COMMUNITY, TECUMSEH, MICHIGAN |journal=Circulation |volume=31 |issue= |pages=888–98 |year=1965 |month=June |pmid=14297523 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=14297523}}</ref>
*The [[prevalence]] of [[atrial fibrillation]] has been increased during the last decades, due to various causes such as improved [[diagnosis|diagnostic tools]], increased in [[Ageing|age]] [[average]] in some populations and higher rate of successful [[treatment]] in [[cardiology|cardiac]] [[patients]].<ref name="pmid24966695">{{cite journal| author=Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S| title=Epidemiology of atrial fibrillation: European perspective. | journal=Clin Epidemiol | year= 2014 | volume= 6 | issue=  | pages= 213-20 | pmid=24966695 | doi=10.2147/CLEP.S47385 | pmc=4064952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24966695  }} </ref>
*[[Prevalence]] of [[atrial fibrillation]] has been estimated to be even more, since many cases of [[atrial fibrillation]] remain [[symptom|asymptomatic]] for a long time.<ref name="pmid16253649">{{cite journal| author=Rho RW, Page RL| title=Asymptomatic atrial fibrillation. | journal=Prog Cardiovasc Dis | year= 2005 | volume= 48 | issue= 2 | pages= 79-87 | pmid=16253649 | doi=10.1016/j.pcad.2005.06.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16253649  }} </ref>
*Approximately 2.2&nbsp;million individuals in the United States and 4.5&nbsp;million in the European Union have [[atrial fibrillation]].<ref name="pmid16908781"/><ref>{{cite journal |author=Go AS, Hylek EM, Phillips KA, ''et al'' |title=Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study |journal=JAMA |volume=285 |issue=18 |pages=2370–5 |year=2001 |pmid=11343485|doi=10.1001/jama.285.18.2370}}</ref>


Atrial fibrillation is the most common arrhythmia found in clinical practice.<ref name="pmid16908781"/> It also accounts for 1/3 of hospital admissions for cardiac rhythm disturbances<ref name="pmid16908781"/>, and the rate of admissions for AF has risen in recent years.<ref name="Friberg-2003">{{cite journal | author=Friberg J, Buch P, Scharling H, Gadsbphioll N, Jensen GB. | title=Rising rates of hospital admissions for atrial fibrillation | journal=Epidemiology | year=2003 | volume=14 | issue=6 | pages=666–72 | pmid=14569181 | doi=10.1097/01.ede.0000091649.26364.c0}}</ref> Approximately 2.2&nbsp;million individuals in the United States and 4.5&nbsp;million in the European Union have AF.<ref name="pmid16908781"/><ref>{{cite journal |author=Go AS, Hylek EM, Phillips KA, ''et al'' |title=Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study |journal=JAMA |volume=285 |issue=18 |pages=2370–5 |year=2001 |pmid=11343485|doi=10.1001/jama.285.18.2370}}</ref>
===Case-fatality rate/Mortality rate===
*[[Atrial fibrillation]] is associated with a 1.5 to 1.9 fold increase in the risk of death.<ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 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 of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref> 
*The [[mortality rate]] of [[patients]] with [[atrial fibrillation]] is nearly double that of [[patients]] with normal [[sinus rhythm]]. This increase is due not only to [[atrial fibrillation]] alone but also due to the severity of possible underlying [[diseases]], and is often due to [[thromboembolism|thromboembolic events]].<ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 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 of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref>
*The administration of [[medications]] aimed at rate control alone offers no survival advantage over the use of rate control along with [[anticoagulation]] as demonstrated in the AFFIRM trial.<ref>Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. Dec 5 2002;347(23):1825-33.</ref>
*The following table is a summary regard the increased [[mortality rate]] after [[atrial fibrillation]] development:<ref name="pmid24966695">{{cite journal| author=Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S| title=Epidemiology of atrial fibrillation: European perspective. | journal=Clin Epidemiol | year= 2014 | volume= 6 | issue=  | pages= 213-20 | pmid=24966695 | doi=10.2147/CLEP.S47385 | pmc=4064952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24966695  }} </ref><ref name="pmid22235070">{{cite journal| author=Piccini JP, Hammill BG, Sinner MF, Jensen PN, Hernandez AF, Heckbert SR | display-authors=etal| title=Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993-2007. | journal=Circ Cardiovasc Qual Outcomes | year= 2012 | volume= 5 | issue= 1 | pages= 85-93 | pmid=22235070 | doi=10.1161/CIRCOUTCOMES.111.962688 | pmc=3332107 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22235070  }} </ref>
<br>
{| style="border: 2px solid #4479BA; align="left"
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|[[Mortality rate]] within 30 days of [[atrial fibrillation]] development}}
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 10.8 %
|-
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|[[Mortality rate]] in first year of [[atrial fibrillation]] development}}
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 24.7%
|-
! style="width: 400px; background: #4479BA;" | {{fontcolor|#FFF|[[Mortality rate]] within 3 first years of [[atrial fibrillation]] development}}
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 42%
|}
<br>
*A study done on Swedish population with 24 years follow up demonstrated the [[mortality rate]] is specifically higher within the first 4 months of [[diagnosis]] (67%).<ref name="pmid17336723">{{cite journal| author=Miyasaka Y, Barnes ME, Bailey KR, Cha SS, Gersh BJ, Seward JB | display-authors=etal| title=Mortality trends in patients diagnosed with first atrial fibrillation: a 21-year community-based study. | journal=J Am Coll Cardiol | year= 2007 | volume= 49 | issue= 9 | pages= 986-92 | pmid=17336723 | doi=10.1016/j.jacc.2006.10.062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17336723  }} </ref>


The incidence of atrial fibrillation increases with age. The prevalence in individuals over the age of 80 is about 8%.<ref>{{cite journal |author=Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM |title=Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study) |journal=Am. J. Cardiol. |volume=74 |issue=3 |pages=236–41 |year=1994 |pmid=8037127|doi=10.1016/0002-9149(94)90363-8}}</ref> In developed countries, the number of patients with atrial fibrillation is likely to increase during the next 50&nbsp;years, due to the growing proportion of elderly individuals.<ref>{{cite journal | author=Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE | title=Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study | journal=JAMA | year=2001 | pages=2370–5 | volume=285 | issue=18 | doi=10.1001/jama.285.18.2370 | pmid=11343485}} PMID 11343485</ref>
===Age===
*The [[incidence]] of [[atrial fibrillation]] increases with [[Ageing|age]].<ref name="pmid11156892">{{cite journal| author=Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ | display-authors=etal| title=Pathophysiology and prevention of atrial fibrillation. | journal=Circulation | year= 2001 | volume= 103 | issue= 5 | pages= 769-77 | pmid=11156892 | doi=10.1161/01.cir.103.5.769 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11156892  }} </ref><ref name="pmid28450367">{{cite journal| author=Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH| title=Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. | journal=Circ Res | year= 2017 | volume= 120 | issue= 9 | pages= 1501-1517 | pmid=28450367 | doi=10.1161/CIRCRESAHA.117.309732 | pmc=5500874 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28450367  }} </ref><ref name="pmid11601835">{{cite journal |author=Fuster V, Rydén LE, Asinger RW, ''et al'' |title=ACC/AHA/ESC 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 of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology |journal=Eur. Heart J. |volume=22 |issue=20 |pages=1852–923 |year=2001 |month=October |pmid=11601835 |doi=10.1053/euhj.2001.2983 |url=}}</ref><ref>{{cite journal |author=Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM |title=Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study) |journal=Am. J. Cardiol. |volume=74 |issue=3 |pages=236–41 |year=1994 |pmid=8037127|doi=10.1016/0002-9149(94)90363-8}}</ref><ref name="pmid22949543">{{cite journal| author=McManus DD, Rienstra M, Benjamin EJ| title=An update on the prognosis of patients with atrial fibrillation. | journal=Circulation | year= 2012 | volume= 126 | issue= 10 | pages= e143-6 | pmid=22949543 | doi=10.1161/CIRCULATIONAHA.112.129759 | pmc=3678907 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22949543  }} </ref>
*The [[prevalence]] of [[patients]] with [[atrial fibrillation]] in individuals over the age of 80 is about 10-17%. While only 3.7%–4.2% of [[patients]] aged 60–70 year have [[atrial fibrillation]].<ref name="pmid24966695">{{cite journal| author=Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S| title=Epidemiology of atrial fibrillation: European perspective. | journal=Clin Epidemiol | year= 2014 | volume= 6 | issue=  | pages= 213-20 | pmid=24966695 | doi=10.2147/CLEP.S47385 | pmc=4064952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24966695  }} </ref>
*[[Patients]] with [[atrial fibrillation]] have a [[median]] age of 75 years. 
*The proportion of [[patients]] with [[atrial fibrillation]] who are between 65 and 85 years of age is 70%.<ref name="pmid7864703">{{cite journal |author=Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG |title=Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications |journal=Arch. Intern. Med. |volume=155 |issue=5 |pages=469–73 |year=1995 |month=March |pmid=7864703 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=7864703}}</ref>


==Prevalence==
===Race===
It should be noted that the prevalence of atrial fibrillation increases with increasing age, and its prevalence is increased among Caucasians, patients with hypertension and valvular heart disease<ref name="pmid11601835">{{cite journal |author=Fuster V, Rydén LE, Asinger RW, ''et al'' |title=ACC/AHA/ESC 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 of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology |journal=Eur. Heart J. |volume=22 |issue=20 |pages=1852–923 |year=2001 |month=October |pmid=11601835 |doi=10.1053/euhj.2001.2983 |url=}}</ref>. The prevalence in the general population is 0.4%.<ref name="pmid14297523">{{cite journal |author=OSTRANDER LD, BRANDT RL, KJELSBERG MO, EPSTEIN FH |title=ELECTROCARDIOGRAPHIC FINDINGS AMONG THE ADULT POPULATION OF A TOTAL NATURAL COMMUNITY, TECUMSEH, MICHIGAN |journal=Circulation |volume=31 |issue= |pages=888–98 |year=1965 |month=June |pmid=14297523 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=14297523}}</ref>
*[[Prevalence]] of [[atrial fibrillation]] has been reported to be higher among Caucasians (European ancestry).<ref name="pmid28450367">{{cite journal| author=Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH| title=Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. | journal=Circ Res | year= 2017 | volume= 120 | issue= 9 | pages= 1501-1517 | pmid=28450367 | doi=10.1161/CIRCRESAHA.117.309732 | pmc=5500874 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28450367  }} </ref>
*Important [[Genetics|genetic determinants]] may play a role since the age-adjusted risk of developing [[atrial fibrillation]] among African-Americans is less than half that in Caucasians.<ref name="pmid">{{cite journal |author=Flegel KM, Shipley MJ, Rose G |title=Risk of stroke in non-rheumatic atrial fibrillation |journal=Lancet |volume=1 |issue=8532 |pages=526–9 |year=1987 |month=March |pmid= |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(87)90174-7}}</ref><ref name="pmid1866765">{{cite journal |author=Wolf PA, Abbott RD, Kannel WB |title=Atrial fibrillation as an independent risk factor for stroke: the Framingham Study |journal=Stroke |volume=22 |issue=8 |pages=983–8 |year=1991 |month=August |pmid=1866765 |doi= |url=http://stroke.ahajournals.org/cgi/pmidlookup?view=long&pmid=1866765}}</ref> <ref name="pmid8037127">{{cite journal |author=Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM |title=Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study) |journal=Am. J. Cardiol. |volume=74 |issue=3 |pages=236–41 |year=1994 |month=August |pmid=8037127 |doi= |url=}}</ref>


Important genetic determinants may play a role in so far as the age-adjusted risk of developing atrial fibrillation among African-Americans is less than half that in Caucasians. <ref name="pmid">{{cite journal |author=Flegel KM, Shipley MJ, Rose G |title=Risk of stroke in non-rheumatic atrial fibrillation |journal=Lancet |volume=1 |issue=8532 |pages=526–9 |year=1987 |month=March |pmid= |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(87)90174-7}}</ref><ref name="pmid1866765">{{cite journal |author=Wolf PA, Abbott RD, Kannel WB |title=Atrial fibrillation as an independent risk factor for stroke: the Framingham Study |journal=Stroke |volume=22 |issue=8 |pages=983–8 |year=1991 |month=August |pmid=1866765 |doi= |url=http://stroke.ahajournals.org/cgi/pmidlookup?view=long&pmid=1866765}}</ref> <ref name="pmid8037127">{{cite journal |author=Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM |title=Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study) |journal=Am. J. Cardiol. |volume=74 |issue=3 |pages=236–41 |year=1994 |month=August |pmid=8037127 |doi= |url=}}</ref> The presence of atrial fibrillation often reflects the presence of underlying cardiac or lung disease.  Indeed, the proportion of patients with “lone” atrial fibrillation, (that is those patients with atrial fibrillation in whom there is no cardiac or lung disease history) is low at about 12% of cases. <ref name="pmid3627174">{{cite journal |author=Kopecky SL, Gersh BJ, McGoon MD, ''et al'' |title=The natural history of lone atrial fibrillation. A population-based study over three decades |journal=N. Engl. J. Med. |volume=317 |issue=11 |pages=669–74 |year=1987 |month=September |pmid=3627174 |doi= |url=}}</ref><ref name="pmid8037127">{{cite journal |author=Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM |title=Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study) |journal=Am. J. Cardiol. |volume=74 |issue=3 |pages=236–41 |year=1994 |month=August |pmid=8037127 |doi= |url=}}</ref><ref name="pmid13160271">{{cite journal |author=EVANS W, SWANN P |title=Lone auricular fibrillation |journal=Br Heart J |volume=16 |issue=2 |pages=189–94 |year=1954 |month=April |pmid=13160271 |pmc=479515 |doi= |url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=13160271}}</ref><ref name="pmid4068186">{{cite journal |author=Brand FN, Abbott RD, Kannel WB, Wolf PA |title=Characteristics and prognosis of lone atrial fibrillation. 30-year follow-up in the Framingham Study |journal=JAMA |volume=254 |issue=24 |pages=3449–53 |year=1985 |month=December |pmid=4068186 |doi= |url=}}</ref> Patients with atrial fibrillation tend to be older with a median age of 75 years. The proportion of patients with atrial fibrillation who are between 65 and 85 years of age is 70%, and females predominate in the very elderly (60% of atrial fibrillation patients over the age of 75 are women).<ref name="pmid7864703">{{cite journal |author=Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG |title=Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications |journal=Arch. Intern. Med. |volume=155 |issue=5 |pages=469–73 |year=1995 |month=March |pmid=7864703 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=7864703}}</ref>  Despite the fact that there are more very elderly women with atrial fibrillation, when age is adjusted for, the prevalence of atrial fibrillation is higher in men.<ref name="pmid8037127">{{cite journal |author=Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM |title=Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study) |journal=Am. J. Cardiol. |volume=74 |issue=3 |pages=236–41 |year=1994 |month=August |pmid=8037127 |doi= |url=}}</ref><ref name="pmid6869222">{{cite journal |author=Kannel WB, Abbott RD, Savage DD, McNamara PM |title=Coronary heart disease and atrial fibrillation: the Framingham Study |journal=Am. Heart J. |volume=106 |issue=2 |pages=389–96 |year=1983 |month=August |pmid=6869222 |doi= |url=}}</ref>  The rate of rise per year in the risk of atrial fibrillation is slightly higher in the very elderly (1.5% per year for women and 2.0% per year for men over the age of 80 years).  These rates are nearly 15 to 20 times higher than in those under the age of 40.<ref name="pmid9337224">{{cite journal |author=Psaty BM, Manolio TA, Kuller LH, ''et al'' |title=Incidence of and risk factors for atrial fibrillation in older adults |journal=Circulation |volume=96 |issue=7 |pages=2455–61 |year=1997 |month=October |pmid=9337224 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9337224}}</ref><ref name="pmid3632164">{{cite journal |author=Wolf PA, Abbott RD, Kannel WB |title=Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study |journal=Arch. Intern. Med. |volume=147 |issue=9 |pages=1561–4 |year=1987 |month=September |pmid=3632164 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=3632164}}</ref><ref name="pmid7733127">{{cite journal |author=Krahn AD, Manfreda J, Tate RB, Mathewson FA, Cuddy TE |title=The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study |journal=Am. J. Med. |volume=98 |issue=5 |pages=476–84 |year=1995 |month=May |pmid=7733127 |doi=10.1016/S0002-9343(99)80348-9 |url=}}</ref>
===Gender===
*[[Atrial fibrillation]] is more common in [[males]] compared to [[females]].<ref name="pmid24966695">{{cite journal| author=Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S| title=Epidemiology of atrial fibrillation: European perspective. | journal=Clin Epidemiol | year= 2014 | volume= 6 | issue= | pages= 213-20 | pmid=24966695 | doi=10.2147/CLEP.S47385 | pmc=4064952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24966695  }} </ref><ref name="pmid28450367">{{cite journal| author=Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH| title=Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. | journal=Circ Res | year= 2017 | volume= 120 | issue= 9 | pages= 1501-1517 | pmid=28450367 | doi=10.1161/CIRCRESAHA.117.309732 | pmc=5500874 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28450367  }} </ref>
*The [[male]] to [[female]] ratio has been reported as 1.2:1 in [[atrial fibrillation]] [[patients]].
*There are more [[old age|elderly]] [[female|women]] with [[atrial fibrillation]], compared to [[males|men]] which is due to longer life among [[female]] [[patients]].<ref name="pmid8037127">{{cite journal |author=Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM |title=Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study) |journal=Am. J. Cardiol. |volume=74 |issue=3 |pages=236–41 |year=1994 |month=August |pmid=8037127 |doi= |url=}}</ref><ref name="pmid6869222">{{cite journal |author=Kannel WB, Abbott RD, Savage DD, McNamara PM |title=Coronary heart disease and atrial fibrillation: the Framingham Study |journal=Am. Heart J. |volume=106 |issue=2 |pages=389–96 |year=1983 |month=August |pmid=6869222 |doi= |url=}}</ref>


==See Also==
===Region===
* [[The Living Guidelines: Diagnosis and Management of Atrial Fibrillation | The AF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
The following table is a summary of how rate of [[atrial fibrillation]] differs among various regions: <ref name="pmid24966695">{{cite journal| author=Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S| title=Epidemiology of atrial fibrillation: European perspective. | journal=Clin Epidemiol | year= 2014 | volume= 6 | issue=  | pages= 213-20 | pmid=24966695 | doi=10.2147/CLEP.S47385 | pmc=4064952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24966695  }} </ref>
{| style="border: 2px solid #4479BA; align="left"
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Regions}}
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|[[Prevalence]]}}
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Italy
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 1.9 %
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | England
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 1.9 %
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Iceland
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 1.9 %
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Germany
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 2.3 %
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Sweden
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 2.9%
|-
|}
===Developed Countries===
In developed countries, the number of patients with atrial fibrillation is likely to increase during the next 50&nbsp;years, due to the growing proportion of [[old age|elderly]] individuals.<ref>{{cite journal | author=Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE | title=Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study | journal=JAMA | year=2001 | pages=2370–5 | volume=285 | issue=18  | doi=10.1001/jama.285.18.2370 | pmid=11343485}} PMID 11343485</ref>
===Developing Countries===
*[[Prevalence]] of [[atrial fibrillation]] in developing countries has estimated as 0.4 % in [[female]] and 0.6% in [[male]] populations.<ref name="pmid24966695">{{cite journal| author=Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S| title=Epidemiology of atrial fibrillation: European perspective. | journal=Clin Epidemiol | year= 2014 | volume= 6 | issue=  | pages= 213-20 | pmid=24966695 | doi=10.2147/CLEP.S47385 | pmc=4064952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24966695  }} </ref>


==References==
==References==
{{reflist|2}}
{{reflist|2}}
 
[[CME Category::Cardiology]]
==Further Readings==
{{refbegin|2}}
* Fuster V, Rydén LE, Cannom DS, et al (2006). "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 of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation 114 (7): e257-354. doi:10.1161/CIRCULATIONAHA.106.177292. PMID 16908781.
* Estes NAM 3rd, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS, McNamara RL, Messer JV, Ritchie JL, Romeo SJW, Waldo AL, Wyse DG. ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with non valvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Performance Measures for Atrial Fibrillation). Circulation 2008; 117:1101–1120
{{refend}}
 
{{Electrocardiography}}
{{Circulatory system pathology}}


[[Category:Electrophysiology]]
[[Category:Electrophysiology]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[de:Vorhofflimmern]]
[[fr:Fibrillation auriculaire]]
[[it:Fibrillazione atriale]]
[[nl:Boezemfibrilleren]]
[[ja:心房細動]]
[[no:Atrieflimmer]]
[[pl:Migotanie przedsionków]]
[[ro:Fibrilaţia Atrială]]
[[fi:Eteisvärinä]]
[[zh:心房颤动]]
[[tr:Atriyal fibrillasyon]]
{{WH}}
{{WS}}

Latest revision as of 04:04, 30 August 2021
Resident
Survival
Guide


Sinus rhythm
Atrial fibrillation

Atrial Fibrillation Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]

Overview

Incidence of atrial fibrillation is approximately less than 0.1% per year in those under 40 years of age. On the other hand incidence rate increases to greater than 1.5% per year in women over 80 age and greater than 2% per year in men over 80 years of age. The atrial fibrillation prevalence in the general population is 0.4%. Prevalence of atrial fibrillation has been estimated to be even more, since many cases of atrial fibrillation remain asymptomatic for a long time. Atrial fibrillation is associated with a 1.5 to 1.9 fold increase in the risk of death. The incidence of atrial fibrillation increases with age (median age of 75 years). Prevalence of atrial fibrillation has been reported to be higher among Caucasians (European ancestry) and it is more common in males compared to females.

Epidemiology and Demographics

Incidence

Prevalence

Case-fatality rate/Mortality rate


Mortality rate within 30 days of atrial fibrillation development 10.8 %
Mortality rate in first year of atrial fibrillation development 24.7%
Mortality rate within 3 first years of atrial fibrillation development 42%


  • A study done on Swedish population with 24 years follow up demonstrated the mortality rate is specifically higher within the first 4 months of diagnosis (67%).[10]

Age

Race

Gender

Region

The following table is a summary of how rate of atrial fibrillation differs among various regions: [3]

Regions Prevalence
Italy 1.9 %
England 1.9 %
Iceland 1.9 %
Germany 2.3 %
Sweden 2.9%

Developed Countries

In developed countries, the number of patients with atrial fibrillation is likely to increase during the next 50 years, due to the growing proportion of elderly individuals.[21]

Developing Countries

References

  1. ↑ 1.0 1.1 1.2 1.3 PMID 16908781 (PMID 16908781)
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  2. ↑ 2.0 2.1 Piccini JP, Hammill BG, Sinner MF, Jensen PN, Hernandez AF, Heckbert SR; et al. (2012). "Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993-2007". Circ Cardiovasc Qual Outcomes. 5 (1): 85–93. doi:10.1161/CIRCOUTCOMES.111.962688. PMC 3332107. PMID 22235070.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S (2014). "Epidemiology of atrial fibrillation: European perspective". Clin Epidemiol. 6: 213–20. doi:10.2147/CLEP.S47385. PMC 4064952. PMID 24966695.
  4. ↑ Murphy NF, Simpson CR, Jhund PS, Stewart S, Kirkpatrick M, Chalmers J; et al. (2007). "A national survey of the prevalence, incidence, primary care burden and treatment of atrial fibrillation in Scotland". Heart. 93 (5): 606–12. doi:10.1136/hrt.2006.107573. PMC 1955558. PMID 17277353.
  5. ↑ Wilke T, Groth A, Mueller S, Pfannkuche M, Verheyen F, Linder R; et al. (2013). "Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients". Europace. 15 (4): 486–93. doi:10.1093/europace/eus333. PMID 23220354.
  6. ↑ OSTRANDER LD, BRANDT RL, KJELSBERG MO, EPSTEIN FH (1965). "ELECTROCARDIOGRAPHIC FINDINGS AMONG THE ADULT POPULATION OF A TOTAL NATURAL COMMUNITY, TECUMSEH, MICHIGAN". Circulation. 31: 888–98. PMID 14297523. Unknown parameter |month= ignored (help)
  7. ↑ Rho RW, Page RL (2005). "Asymptomatic atrial fibrillation". Prog Cardiovasc Dis. 48 (2): 79–87. doi:10.1016/j.pcad.2005.06.005. PMID 16253649.
  8. ↑ Go AS, Hylek EM, Phillips KA; et al. (2001). "Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study". JAMA. 285 (18): 2370–5. doi:10.1001/jama.285.18.2370. PMID 11343485.
  9. ↑ Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. Dec 5 2002;347(23):1825-33.
  10. ↑ Miyasaka Y, Barnes ME, Bailey KR, Cha SS, Gersh BJ, Seward JB; et al. (2007). "Mortality trends in patients diagnosed with first atrial fibrillation: a 21-year community-based study". J Am Coll Cardiol. 49 (9): 986–92. doi:10.1016/j.jacc.2006.10.062. PMID 17336723.
  11. ↑ Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ; et al. (2001). "Pathophysiology and prevention of atrial fibrillation". Circulation. 103 (5): 769–77. doi:10.1161/01.cir.103.5.769. PMID 11156892.
  12. ↑ 12.0 12.1 12.2 Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH (2017). "Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes". Circ Res. 120 (9): 1501–1517. doi:10.1161/CIRCRESAHA.117.309732. PMC 5500874. PMID 28450367.
  13. ↑ Fuster V, Rydén LE, Asinger RW; et al. (2001). "ACC/AHA/ESC 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 of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology". Eur. Heart J. 22 (20): 1852–923. doi:10.1053/euhj.2001.2983. PMID 11601835. Unknown parameter |month= ignored (help)
  14. ↑ Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM (1994). "Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study)". Am. J. Cardiol. 74 (3): 236–41. doi:10.1016/0002-9149(94)90363-8. PMID 8037127.
  15. ↑ McManus DD, Rienstra M, Benjamin EJ (2012). "An update on the prognosis of patients with atrial fibrillation". Circulation. 126 (10): e143–6. doi:10.1161/CIRCULATIONAHA.112.129759. PMC 3678907. PMID 22949543.
  16. ↑ Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG (1995). "Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications". Arch. Intern. Med. 155 (5): 469–73. PMID 7864703. Unknown parameter |month= ignored (help)
  17. ↑ Flegel KM, Shipley MJ, Rose G (1987). "Risk of stroke in non-rheumatic atrial fibrillation". Lancet. 1 (8532): 526–9. Unknown parameter |month= ignored (help)
  18. ↑ Wolf PA, Abbott RD, Kannel WB (1991). "Atrial fibrillation as an independent risk factor for stroke: the Framingham Study". Stroke. 22 (8): 983–8. PMID 1866765. Unknown parameter |month= ignored (help)
  19. ↑ 19.0 19.1 Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM (1994). "Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study)". Am. J. Cardiol. 74 (3): 236–41. PMID 8037127. Unknown parameter |month= ignored (help)
  20. ↑ Kannel WB, Abbott RD, Savage DD, McNamara PM (1983). "Coronary heart disease and atrial fibrillation: the Framingham Study". Am. Heart J. 106 (2): 389–96. PMID 6869222. Unknown parameter |month= ignored (help)
  21. ↑ Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE (2001). "Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study". JAMA. 285 (18): 2370–5. doi:10.1001/jama.285.18.2370. PMID 11343485. PMID 11343485

CME Category::Cardiology

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