Global, regional, and national burden of atrial fibrillation and flutter and associated heart failure from 1990 to 2021 and projections to 2050: insights from the Global Burden of Disease Study 2021

Background Atrial fibrillation (AF) and atrial flutter (AFL) are growing global health concerns. The increasing burden of these conditions highlights the need for comprehensive insights into their global impact and epidemiological trends. This study assesses the global burden and trends of AF/AFL, as well as AF/AFL-associated heart failure over time: 1990 to 2021, with forecasts to 2050. Methods We leveraged data from the Global Burden of Disease (GBD) study 2021 to examine the burden and trends of AF/AFL and associated heart failure across 204 countries and territories from 1990 to 2021. The incidence, prevalence, disability-adjusted life years (DALY), years lived with disability (YLD), and average annual percentage changes were computed. A Bayesian Age-Period-Cohort (BAPC) model was applied to forecast the trends of AF/AFL from 2022 to 2050. Results The number of incidence, prevalence, DALY, and YLD for AF/AFL, as well as the burden of AF/AFL-related heart failure, significantly increased from 1990 to 2021. However, age-standardized rates for these metrics showed only minor fluctuations. The burden was highest among the elderly and varied by sociodemographic index (SDI), with the greatest increase observed in the middle SDI region. Global increases in AF/AFL burden were primarily driven by population growth and aging. Projections indicate that the AF/AFL burden will continue rising through 2050. Conclusion The global burden of AF/AFL and associated heart failure has steadily increased. Public health strategies targeting high-burden regions and the elderly are required to mitigate its impact on global public health.