Epidemiology and Economic Burden of Atrial Fibrillation

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Citation
US Cardiology, 2007;4(1):14-7

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Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia and is characterized by unco-ordinated atrial activation with consequent loss of atrial mechanical function. In developed nations, the number of men and women affected by AF is projected to more than double over the next two decades. Despite major advances in its management, AF remains a significant cause of cardiovascular morbidity and mortality, especially that arising from stroke and heart failure. This article reviews the epidemiology, cost of management, and future burden of AF.

Classification

In the past, AF has been classified inconsistently in various studies, which has led to difficulties in the comparison and collection of epidemiological data. The current guidelines of the American College of Cardiology, the American Heart Association, and the European Society of Cardiology suggest a simple classification based on the temporal progression of the arrhythmia.1 The classification has four categories:

  • first detected episode of AF;
  • paroxysmal AF (self-terminating episodes lasting no longer than seven days, commonly less than 24 hours);
  • persistent AF (non-self-terminating episodes lasting more than seven days, requiring electrical or pharmacological cardioversion to terminate); and
  • permanent AF (fails to terminate after cardioversion, or is accepted by the patient and the physician).

Paroxysmal and persistent AF may be recurrent and are often progressive. Using the above definitions, a recent general practice-based French study found that permanent AF accounted for 50% of cases, with 25% each for persistent and paroxysmal AF.2 Data from the Canadian Registry of Atrial Fibrillation (CARAF) suggest that among 757 patients with new-onset paroxysmal AF, approximately 8–9% may progress to permanent AF by the end of one year, a figure that increases to 25% by five years.3 Rates appear to be higher for those with persistent AF, with 40% developing permanent AF by the end of one year.4

 

Associated Cardiovascular Conditions

AF is common in patients with structural heart disease. While in developing countries rheumatic valvular disease remains a major etiological factor for AF, the spectrum in Western populations has shifted to hypertension, atherosclerotic heart disease, congestive heart failure, valvular heart disease (mainly mitral stenosis), and diabetes mellitus as the most common risk factors for the development and sustenance of AF (see Table 1).5

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