Bill & Melinda Gates Foundation.

No abstract

Bill & Melinda Gates Foundation.

Background The global burden of atrial fibrillation (AF) is unknown. Methods and Results We systematically reviewed population-based studies of AF published 1980–2010, from the 21 Global Burden of Disease (GBD) regions to estimate global/regional prevalence, incidence, as well as morbidity and mortality related to AF (DisModMR software). Of 377 potential studies identified, 184 met pre-specified eligibility criteria. The estimated number of individuals with AF globally in 2010 was 33·5 million [(20·9 million males (UI, 19·5–22·2 million) and 12·6 million females (UI, 12·0–13·7 million)]. 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. In 1990, the estimated age-adjusted prevalence rates of AF (per 100,000 population) were 569·5 in males [95% uncertainty interval (UI), 532·8–612·7] and 359·9 in females (UI, 334·7–392·6); 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). In 2010 the prevalence rate increased to 596·2 (UI, 558·4–636·7) in males and 373·1 (UI, 347·9–402·2) in females; incidence rate increased to 77·5 (UI, 65·2–95·4) in males and 59·5 (UI, 49·9–74·9) 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. Conclusions These findings provide evidence of progressive increases in overall burden, incidence, prevalence and AF-associated mortality between 1990–2010. Systematic, global surveillance of AF is required to better direct prevention and treatment strategies.

Sudden cardiac death accounts for 5.6% of annual mortality, and prospective evaluation in the general population appears to be feasible. The use of multiple sources of ascertainment and information significantly enhances phenotyping of SCD cases. Retrospective death certificate-based surveillance results in significant overestimation of SCD incidence.

In this community-wide study, only one-third of the evaluated SCD cases had severe LV dysfunction meeting current criteria for prophylactic cardioverter-defibrillator implantation. The SCD cases with normal LV function had several distinguishing clinical characteristics. These findings support the aggressive development of alternative screening methods to enhance identification of patients at risk.

In this large cohort of AF patients given aspirin, those with intermittent AF had stroke rates similar to patients with sustained AF and similar stroke risk factors. Many elderly patients with recurrent intermittent AF have substantial rates of stroke and likely benefit from anticoagulation. High-risk patients with intermittent AF can be identified using the same clinical criteria that apply to patients with sustained AF.

In sinus-node dysfunction, dual-chamber pacing does not improve stroke-free survival, as compared with ventricular pacing. However, dual-chamber pacing reduces the risk of atrial fibrillation, reduces signs and symptoms of heart failure, and slightly improves the quality of life. Overall, dual-chamber pacing offers significant improvement as compared with ventricular pacing.