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Incidence and Mortality Trends of Atrial Fibrillation/Atrial Flutter in the United States 1990 to 2017

Published:February 24, 2021DOI:https://doi.org/10.1016/j.amjcard.2021.02.014

      Highlights

      • Atrial fibrillation / Atrial fibrillation flutter incidence and mortality rate has increased in the United States.
      • The greatest incidence rates for men in 2017 were clustered in the New England region.
      • An inflection point in year 2001 is notable for increased incidence and mortality rates for both genders across most states.
      Atrial fibrillation (AF) and flutter (AFL) are the most common clinically significant arrhythmias in older adults with an increasing disease burden due to an aging population. However, up-to-date trends in disease burden and regional variation remain unknown. In an observational study utilizing the Global Burden of Disease (GBD) database, age-standardized mortality and incidence rates for AF overall and for each state in the United States (US) from 1990 to 2017 were determined. All analyses were stratified by gender. The relative change in age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) over the observation period were determined. Trends were analyzed using Joinpoint regression analysis. The mean ASIR per 100,000 population for men was 92 (+/-8) and for women was 62 (+/-5) in the US in 2017. The mean ASDR per 100,000 population for men was 5.8 (+/-0.3) and for women was 4.4 (+/-0.4). There were progressive increases in ASIR and ASDR in all but 1 state. The states with the greatest percentage change in incidence were New Hampshire (+13.5%) and Idaho (+16.0%) for men and women, respectively. The greatest change regarding mortality was seen in Mississippi (+26.3%) for men and Oregon (+53.8%) for women. In conclusion these findings provide updated evidence of increasing AF and/or AFL incidence and mortality on a national and regional level in the US, with women experiencing greater increases in incidence and mortality rates. This study demonstrates that the public health burden related to AF in the United States is progressively worsening but disproportionately across states and among women.
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      REFERENCES

        • Benjamin EJ
        • Wolf PA
        • D'Agostino RB
        • Silbershatz H
        • Kannel WB
        • Levy D
        Impact of atrial fibrillation on the risk of death: the Framingham Heart Study.
        Circulation. 1998; 98: 946-952
        • Kannel WB
        • Wolf PA
        • Benjamin EJ
        • Levy D.
        Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates.
        Am J Cardiol. 1998; 82: 2n-9n
        • Benjamin EJ
        • Levy D
        • Vaziri SM
        • D'Agostino RB
        • Belanger AJ
        • Wolf PA
        Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study.
        Jama. 1994; 271: 840-844
        • Psaty BM
        • Manolio TA
        • Kuller LH
        • Kronmal RA
        • Cushman M
        • Fried LP
        • White R
        • Furberg CD
        • Rautaharju PM.
        Incidence of and risk factors for atrial fibrillation in older adults.
        Circulation. 1997; 96: 2455-2461
        • Vaziri SM
        • Larson MG
        • Benjamin EJ
        • Levy D.
        Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study.
        Circulation. 1994; 89: 724-730
        • Aviles RJ
        • Martin DO
        • Apperson-Hansen C
        • Houghtaling PL
        • Rautaharju P
        • Kronmal RA
        • Tracy RP
        • Van Wagoner DR
        • Psaty BM
        • Lauer MS
        • Chung MK.
        Inflammation as a risk factor for atrial fibrillation.
        Circulation. 2003; 108: 3006-3010
        • Ko D
        • Benson MD
        • Ngo D
        • Yang Q
        • Larson MG
        • Wang TJ
        • Trinquart L
        • McManus DD
        • Lubitz SA
        • Ellinor PT
        • Vasan RS
        • Gerszten RE
        • Benjamin EJ
        • Lin H.
        Proteomics profiling and risk of new-onset atrial fibrillation: framingham heart study.
        J Am Heart Assoc. 2019; 8e010976
        • Weng LC
        • Preis SR
        • Hulme OL
        • Larson MG
        • Choi SH
        • Wang B
        • Trinquart L
        • McManus DD
        • Staerk L
        • Lin H
        • Lunetta KL
        • Ellinor PT
        • Benjamin EJ
        • Lubitz SA.
        Genetic predisposition, clinical risk factor burden, and lifetime risk of atrial fibrillation.
        Circulation. 2018; 137: 1027-1038
        • Guez D
        • Boroumand G
        • Ruggiero NJ
        • Mehrotra P
        • Halpern EJ.
        Automated and manual measurements of the aortic annulus with ECG-Gated Cardiac CT angiography prior to transcatheter aortic valve replacement: comparison with 3D-transesophageal echocardiography.
        Acad Radiol. 2017; 24: 587-593
        • Colilla S
        • Crow A
        • Petkun W
        • Singer DE
        • Simon T
        • Liu X.
        Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population.
        Am J Cardiol. 2013; 112: 1142-1147
        • Mehran R
        • Claessen BE
        • Godino C
        • Dangas GD
        • Obunai K
        • Kanwal S
        • Carlino M
        • Henriques JP
        • Di Mario C
        • Kim YH
        • Park SJ
        • Stone GW
        • Leon MB
        • Moses JW
        • Colombo A.
        Long-term outcome of percutaneous coronary intervention for chronic total occlusions.
        JACC Cardiovasc Interv. 2011; 4: 952-961
        • Kim MH
        • Johnston SS
        • Chu BC
        • Dalal MR
        • Schulman KL.
        Estimation of total incremental health care costs in patients with atrial fibrillation in the United States.
        Circ Cardiovasc Qual Outcomes. 2011; 4: 313-320
        • Hartley A
        • Marshall DC
        • Salciccioli JD
        • Sikkel MB
        • Maruthappu M
        • Shalhoub J.
        Trends in mortality from ischemic heart disease and cerebrovascular disease in Europe: 1980 to 2009.
        Circulation. 2016; 133: 1916-1926
        • Miyasaka Y
        • Barnes ME
        • Gersh BJ
        • Cha SS
        • Bailey KR
        • Abhayaratna WP
        • Seward JB
        • Tsang TSM.
        Secular trends in incidence of atrial fibrillation in olmsted county, Minnesota, 1980 to 2000, and implications on the projections for future prevalence.
        Circulation. 2006; 114: 119-125
        • Piccini JP
        • Sinner MF
        • Greiner MA
        • Hammill BG
        • Fontes JD
        • Daubert JP
        • Ellinor PT
        • Hernandez AF
        • Walkey AJ
        • Heckbert SR
        • Benjamin EJ
        • Curtis LH.
        Outcomes of Medicare beneficiaries undergoing catheter ablation for atrial fibrillation.
        Circulation. 2012; 126: 2200-2207
        • Chamberlain AM
        • Gersh BJ
        • Alonso A
        • Chen LY
        • Berardi C
        • Manemann SM
        • Killian JM
        • Weston SA
        • Roger VL
        Decade-long trends in atrial fibrillation incidence and survival: a community study.
        Am J Med. 2015; 128 (260–267)
        • Chugh SS
        • Havmoeller R
        • Narayanan K
        • Singh D
        • Rienstra M
        • Benjamin EJ
        • Gillum RF
        • Kim YH
        • McAnulty Jr., JH
        • Zheng ZJ
        • Forouzanfar MH
        • Naghavi M
        • Mensah GA
        • Ezzati M
        • Murray CJ
        Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study.
        Circulation. 2014; 129: 837-847
        • Schnabel RB
        • Yin X
        • Gona P
        • Larson MG
        • Beiser AS
        • McManus DD
        • Newton-Cheh C
        • Lubitz SA
        • Magnani JW
        • Ellinor PT
        • Seshadri S
        • Wolf PA
        • Vasan RS
        • Benjamin EJ
        • Levy D.
        50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study.
        Lancet. 2015; 386: 154-162
        • Miyasaka Y
        • Barnes ME
        • Bailey KR
        • Cha SS
        • Gersh BJ
        • Seward JB
        • Tsang TS.
        Mortality trends in patients diagnosed with first atrial fibrillation: a 21-year community-based study.
        J Am Coll Cardiol. 2007; 49: 986-992
        • Frost L
        • Vestergaard P
        • Mosekilde L
        • Mortensen LS.
        Trends in incidence and mortality in the hospital diagnosis of atrial fibrillation or flutter in Denmark, 1980-1999.
        Int J Cardiol. 2005; 103: 78-84
        • Frost L
        • Andersen LV
        • Vestergaard P
        • Husted S
        • Mortensen LS.
        Trend in mortality after stroke with atrial fibrillation.
        Am J Med. 2007; 120: 47-53
        • Baczek VL
        • Chen WT
        • Kluger J
        • Coleman CI.
        Predictors of warfarin use in atrial fibrillation in the United States: a systematic review and meta-analysis.
        BMC Fam Pract. 2012; 13: 5
        • Hsu JC
        • Maddox TM
        • Kennedy KF
        • Katz DF
        • Marzec LN
        • Lubitz SA
        • Gehi AK
        • Turakhia MP
        • Marcus GM.
        Oral anticoagulant therapy prescription in patients with atrial fibrillation across the spectrum of stroke risk: insights from the NCDR PINNACLE registry.
        JAMA Cardiol. 2016; 1: 55-62
        • Penado S
        • Cano M
        • Acha O
        • Hernández JL
        • Riancho JA.
        Atrial fibrillation as a risk factor for stroke recurrence.
        Am J Med. 2003; 114: 206-210
        • Spolarics Z
        • Peña G
        • Qin Y
        • Donnelly RJ
        • Livingston DH.
        Inherent X-Linked genetic variability and cellular mosaicism unique to females contribute to sex-related differences in the innate immune response.
        Front Immunol. 2017; 8: 1455https://doi.org/10.3389/fimmu.2017.01455
        • Marais GAB
        • Gaillard J-M
        • Vieira C
        • Plotton I
        • Sanlaville D
        • Gueyffier F
        • Lemaitre J-F.
        Sex gap in aging and longevity: can sex chromosomes play a role?.
        Biology Sex Diff. 2018; 9: 33