ESC Heart Fail. 2026 Mar 30:xvag094. doi: 10.1093/eschf/xvag094. Online ahead of print.
ABSTRACT
AIMS: To systematically quantify the global, regional, and national burden of heart failure (HF) attributable to atrial fibrillation/flutter (AF/AFL) from 1990 to 2021, and project trends to 2040.
METHODS AND RESULTS: Using Global Burden of Disease (GBD) 2021 data, we analyzed AF/AFL-attributed HF prevalence and years lived with disability (YLDs) across 204 countries, stratified by age, sex, and socio-demographic index (SDI). Joinpoint regression identified temporal inflection points; decomposition analysis quantified contributions from population growth, aging, and epidemiological change; Bayesian age-period-cohort (BAPC) models forecasted burden to 2040. Globally, AF-attributed HF cases increased 3.4-fold, from 162,561 (95% UI: 120,008-213,951) in 1990 to 714,137 (95% UI: 520,543-940,901) in 2021, with age-standardized prevalence rates (ASPR) rising from 5.36 to 8.85 per 100,000 (EAPC: 1.76%, 95% UI: 1.66-1.85%). YLDs increased more than four-fold, from 14,615 (95% UI: 8,848-23,114) to 63,943 (95% UI: 39,058-96,196; EAPC: 1.76%, 95% CI: 1.67-1.85%). High-SDI regions exhibited the highest burden (ASPR: 13.97 (95% UI: 10.31 to 18.36) per 100,000), with epidemiological changes contributing 44% of the absolute increase in high-SDI regions to case growth. Women outnumbered men beyond age 65 (female-to-male ratio: 1.1 at age 65-69, widening to 2.4 at ≥95 years), yet age-standardized rates showed no significant sex difference (female ASPR: 8.91 vs. male ASPR: 8.78 per 100,000). Joinpoint analysis revealed accelerated growth during 1990-2007 (APC: 2.12%, p < 0.05), which decelerated during 2007-2018 (APC: 1.41%, p < 0.05) and plateaued during 2018-2021 (APC: -0.36%, p > 0.05). Projections indicate a near-doubling of global cases to 1,307,469 (95% UI: 661,547-1,953,391) by 2040, corresponding to an ASPR of 8.45 per 100,000 (95% UI: 4.28-12.63).
CONCLUSION: AF/AFL is a major and growing driver of global HF burden, projected to affect 1.3 million individuals by 2040, with disproportionate impact in older adults (≥65 years) and high-SDI regions. Integrating standardized AF management-including systematic screening, anticoagulation, and early rhythm control- into HF prevention pathways represents a critical strategy to mitigate projected increases.
PMID:41911424 | DOI:10.1093/eschf/xvag094