Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights

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Abstract

Accompanying the aging of populations worldwide, and increased survival with chronic diseases, the incidence and prevalence of atrial fibrillation (AF) are rising, justifying the term global epidemic. This multifactorial arrhythmia is intertwined with common concomitant cardiovascular diseases, which share classical cardiovascular risk factors. Targeted prevention programs are largely missing. Prevention needs to start at an early age with primordial interventions at the population level. The public health dimension of AF motivates research in modifiable AF risk factors and improved precision in AF prediction and management. In this review, we summarize current knowledge in an attempt to untangle these multifaceted associations from an epidemiological perspective. We discuss disease trends, preventive opportunities offered by underlying risk factors and concomitant disorders, current developments in diagnosis and risk prediction, and prognostic implications of AF and its complications. Finally, we review current technological (eg, eHealth) and methodological (artificial intelligence) advances and their relevance for future prevention and disease management.

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Most cited references 8

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Consequences of Weight Cycling: An Increase in Disease Risk?

KELLEY STROHACKER, KATIE C. CARPENTER, BRIAN K. MCFARLIN (2009)

Research indicates that weight cycling, or “yo-yo dieting” is a common occurrence in overweight and obese populations. The long term negative health consequences of weight cycling are debated and it is unclear whether or not this weight change pattern poses a greater disease risk compared to obesity maintenance. This review discusses the prevalence of weight cycling and physiological alterations occurring during weight loss that promotes weight regain. We also discuss the effect weight regain has upon adipose tissue in terms of rate and type of accumulation. Also within this review are discussions surrounding the previously published literature based upon human and rodent research. We focus on previous limitations and difference in experimental design that have perhaps resulted in mixed findings concerning independent effects of weight cycling on health parameters. The final purpose of this review is to discuss future directions in evaluating the pro-inflammatory response to weight cycling in order to compare the disease risk compared to obesity maintenance.

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Past alcohol consumption and incident atrial fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study

Shalini Dixit, Alvaro Alonso, Eric Vittinghoff … (2017)

Background Although current alcohol consumption is a risk factor for incident atrial fibrillation (AF), the more clinically relevant question may be whether alcohol cessation is associated with a reduced risk. Methods and results We studied participants enrolled in the Atherosclerosis Risk in Communities Study (ARIC) between 1987 and 1989 without prevalent AF. Past and current alcohol consumption were ascertained at baseline and at 3 subsequent visits. Incident AF was ascertained via study ECGs, hospital discharge ICD-9 codes, and death certificates. Of 15,222 participants, 2,886 (19.0%) were former drinkers. During a median follow-up of 19.7 years, there were 1,631 cases of incident AF, 370 occurring in former consumers. Former drinkers had a higher rate of AF compared to lifetime abstainers and current drinkers. After adjustment for potential confounders, every decade abstinent from alcohol was associated with an approximate 20% (95% CI 11–28%) lower rate of incident AF; every additional decade of past alcohol consumption was associated with a 13% (95% CI 3–25%) higher rate of AF; and every additional drink per day during former drinking was associated with a 4% (95% CI 0–8%) higher rate of AF. Conclusions Among former drinkers, the number of years of drinking and the amount of alcohol consumed may each confer an increased risk of AF. Given that a longer duration of abstinence was associated with a decreased risk of AF, earlier modification of alcohol use may have a greater influence on AF prevention.

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Left Atrial Fibrosis: Role in Atrial Fibrillation Pathophysiology and Treatment Outcomes.

David Spragg (2013)

The mechanisms of atrial fibrillation are complex, and have been the subject of intensive study for over fifty years. There is likely a complex interplay between triggers and substrate that mediates the initiation and maintenance of AF. Increasingly, atrial fibrosis has been recognized as a key component of that substrate, playing a critical role in conduction abnormalities in the left atrium that appear necessary to maintaining AF. In the last several years, our abilities to quantify left atrial fibrosis - both through catheter- and MRI-based techniques - has shed important light on the underlying mechanisms of AF, and on therapeutic strategies to treat AF. Whether our increased appreciation of the role of atrial fibrosis in AF translates into improved efficacy of catheter ablation or anti-arrhythmic therapy, though, remains to be seen. The aim of this review is to summarize clinical investigations of atrial fibrosis as a factor in the development and treatment of atrial fibrillation.

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Author and article information

Contributors

Jelena Kornej: (View ORCID Profile)

Emelia J. Benjamin: (View ORCID Profile)

Renate B. Schnabel: (View ORCID Profile)

Journal

Title: Circulation Research

Abbreviated Title: Circ Res

Publisher: Ovid Technologies (Wolters Kluwer Health)

ISSN (Print): 0009-7330

ISSN (Electronic): 1524-4571

Publication date Created: June 19 2020

Publication date (Print): June 19 2020

Volume: 127

Issue: 1

Pages: 4-20

Affiliations

[1 ]From the National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts & Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center (J.K., E.J.B.), Boston University School of Medicine, MA

[2 ]Department of General and Interventional Cardiology, University Heart & Vascular Center Hamburg Eppendorf, Hamburg, Germany (C.B., R.B.S.)

[3 ]German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck (C.B., R.B.S.).

[4 ]Department of Epidemiology (E.J.B.), Boston University School of Medicine, MA

Article

DOI: 10.1161/CIRCRESAHA.120.316340

PMC ID: 7577553

PubMed ID: 32716709

SO-VID: 973f5577-8479-46f0-b082-99702fdf624a

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