Background— Limited data exist on trends in incidence of atrial fibrillation (AF). We assessed the community-based trends in AF incidence for 1980 to 2000 and provided prevalence projections to 2050. Methods and Results— The adult residents of Olmsted County, Minnesota, who had ECG-confirmed first AF in the period 1980 to 2000 (n=4618) were identified. Trends in age-adjusted incidence were determined and used to construct model-based prevalence estimates. The age- and sex-adjusted incidence of AF per 1000 person-years was 3.04 (95% CI, 2.78 to 3.31) in 1980 and 3.68 (95% CI, 3.42 to 3.95) in 2000. According to Poisson regression with adjustment for age and sex, incidence of AF increased significantly ( P =0.014), with a relative increase of 12.6% (95% CI, 2.1 to 23.1) over 21 years. The increase in age-adjusted AF incidence did not differ between men and women ( P =0.84). According to the US population projections by the US Census Bureau, the number of persons with AF is projected to be 12.1 million by 2050, assuming no further increase in age-adjusted incidence of AF, but 15.9 million if the increase in incidence continues. Conclusions— The age-adjusted incidence of AF increased significantly in Olmsted County during 1980 to 2000. Whether or not this rate of increase continues, the projected number of persons with AF for the United States will exceed 10 million by 2050, underscoring the urgent need for primary prevention strategies against AF development.

ONGESTIVE HEART FAILURE(CHF) is a clinical syndrome defined by characteristic symptoms and physical findings. Echocardiography is often performed in patients with CHF to measure the ejection fraction (EF) and determine if systolic function is reduced, systolic CHF or preserved, diastolic CHF. Comprehensive Doppler echocardiography can now characterize diastolic function directly in addition to measurement of the EF.Cardiovascular diseases (CVDs) such as hypertension, coronary artery disease, and cardiomyopathies often lead to systolic and diastolic ventricular dysfunction. Nearly all patients with systolic dysfunction have some degree of concomitant diastolic dysfunction, specifically, impaired relaxation and variable decreases in ventricular compliance. 1 However, it is now recognized that patients with normal EF can display marked impairment in diastolic function (isolated diastolic dysfunction). 2 Clinically, it has been recognized that some patients with advanced systolic dysfunction remain free of symptoms of CHF. Thus, individuals may have systolic dysfunction without receiv-

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Among pregnant women, the highest risk period for venous thromboembolism and pulmonary embolism in particular is during the postpartum period. Any prophylaxis against these events should be particularly targeted to postpartum women. Although the incidence of pulmonary embolism has decreased over time, the incidence of deep venous thrombosis remains unchanged, indicating the need to better identify pregnant women at increased risk.

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