The global burden of atrial fibrillation and atrial flutter in older adults (≥ 65 years): trends, disparities, and drivers (1990–2021)

Abstract

Background: The global burden of atrial fibrillation (AF) and atrial flutter (AFL), major contributors to stroke and heart failure, has substantially increased since 1990 due to aging populations and improved chronic disease survival. This study analyzed global, regional, and national trends in AF/AFL prevalence, incidence, mortality, and disability-adjusted life years (DALYs) among those aged ≥ 65 years (1990–2021), stratified by age, sex, and socioeconomic development index (SDI). Methods: The Global Burden of Disease (GBD) 2021 dataset provided data on AF/AFL. The analysis included age standardization, average annual percentage change (AAPC) calculations, frontier analysis, and decomposition analysis to quantify the contributions of demographic and epidemiological changes. Results: Global AF/AFL cases in those aged ≥ 65 years increased significantly (1990–2021), with a 203.91% increase in deaths. However, age-standardized rates varied; high-income North America showed the highest prevalence rate in 2021 at 11,815.10 per 100,000. Decomposition analysis showed that the increase was attributable to population aging and growth. Frontier analysis revealed countries with disproportionately high DALYs relative to their SDI. Conclusions: The escalating global burden of AF/AFL in older adults demands targeted interventions and resource allocation to address regional disparities. While demographic changes are primary drivers, further research is crucial to understand the contribution of epidemiological factors and develop effective prevention and management strategies.