The Global Burden of Atrial Fibrillation and Stroke: A Systematic Review of the Epidemiology of Atrial Fibrillation in Regions Outside North America and Europe

doi:10.1378/chest.11-2888

Chest

Volume 142, Issue 6, December 2012, Pages 1489-1498

https://doi.org/10.1378/chest.11-2888 Get rights and content

Background

Although atrial fibrillation (AF) is accepted as the most common sustained cardiac arrhythmia, most published epidemiologic studies focus on predominantly white populations in North America or Europe, and information on AF in nonwhite populations is scarce. The objective of this study was to undertake a systematic review of the published literature on the epidemiology of AF in other regions.

Methods

Systematic literature searches (MEDLINE; 1990-2010) identified epidemiologic studies reporting on the prevalence or incidence of AF, stroke in AF, risk factors for AF, or the use of antithrombotic therapy in countries outside North America and Europe. This report presents a descriptive analysis of the data; no meta-analysis was planned.

Results

Many of the 38 articles identified were from the Far East, although Australia, New Zealand, the Middle East, and South America were also represented. The reported prevalence of AF varied among countries, with different ranges in community- and hospital-based studies (0.1%–4% and 2.8%–14%, respectively). The use of anticoagulant therapy varied widely among countries and studies, as did the reported prevalence of stroke in patients with AF (2.8%–24.2%).

Conclusions

High-quality epidemiologic studies are clearly required to improve understanding of the worldwide burden of AF and stroke in AF. Major improvements in the provision of thromboprophylaxis are also needed in many countries, given the high proportion of untreated patients who are, hence, at risk of stroke.

Section snippets

Materials and Methods

Comprehensive literature searches were performed using MEDLINE for studies published between January 1, 1990, and October 14, 2010, that reported on the epidemiology of AF, stroke in AF, risk factors for AF, or antithrombotic therapy use in AF, in populations outside North America and Europe. Search terms included “atrial fibrillation,” “epidemiology,” “prevalence,” “incidence,” “risk factors,” “stroke,” “thromboembolism,” “transient ischemic attack,” and names of countries and regions,

Results

A total of 692 articles were retrieved by literature searches for reports on the epidemiology of AF in regions outside North America and Europe. Of these, 38 articles qualified for inclusion according to the prespecified eligibility criteria (Fig 1). Community-based studies accounted for 23 of the included articles; the remaining 15 articles described hospital-based cohorts. The majority of the included studies were performed in Japan (14 articles) or China (eight articles). Other countries

Discussion

This systematic review reveals marked variability in the reported prevalence of AF among countries outside North America and Europe, and clearly illustrates the differences in prevalence data derived from community- and hospital-based cohort studies. The use of antithrombotic therapy has been shown to vary widely among countries and among cohorts from the same country, and such variation is also shown in the reported prevalence of stroke.

Differences in the availability of data from suitably

Conclusions

High-quality epidemiologic studies are needed to improve our understanding of the global burden of AF, along with greater efforts to improve the provision of thromboprophylaxis in many countries. The data presented here suggest that there is a highly variable prevalence of AF among countries, with low rates reported in an Indian study and several Chinese cohorts, and other studies from the Far East reporting values more in line with the prevalence in North America and Europe. In this analysis,

Acknowledgments

Author contributions: Dr Lip: contributed to the idea for the article and wrote the first draft of the text and subsequent revisions.

Dr Brechin: contributed to the systematic review, formulated the evidence tables, and contributed manuscript revisions.

Dr Lane: contributed to the drafting of the text and manuscript revisions.

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Lip has served as a consultant for Bayer; Astellas Pharma US,

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View all citing articles on Scopus

For editorial comment see page 1368

Funding/Support: Funding for the systematic literature review was provided by Bayer Healthcare AG.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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Chest

Original ResearchCardiovascular DiseaseFeaturedThe Global Burden of Atrial Fibrillation and Stroke: A Systematic Review of the Epidemiology of Atrial Fibrillation in Regions Outside North America and Europe

Background

Methods

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Conclusions

Acknowledgments

Am J Cardiol

Int J Cardiol

J Am Coll Cardiol

Am Heart J

Int J Cardiol

Int J Cardiol

Int J Cardiol

J Stroke Cerebrovasc Dis

Int J Cardiol

J Electrocardiol

Int J Cardiol

Clin Ther

Chest

Chest

Lancet

Am Heart J

Chest

Chest

Can J Cardiol

Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study

JAMA

Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)

Eur Heart J

Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study

Heart

Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence

Circulation

Acute admissions with atrial fibrillation in a British multiracial hospital population

Br J Clin Pract

Treatment of atrial fibrillation in a district general hospital

Br Heart J

Usefulness of ambulatory 7-day ECG monitoring for the detection of atrial fibrillation and flutter after acute stroke and transient ischemic attack

Stroke

Noninvasive cardiac monitoring for detecting paroxysmal atrial fibrillation or flutter after acute ischemic stroke: a systematic review

Stroke

Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study

Arch Intern Med

Prolonged rhythm monitoring for the detection of occult paroxysmal atrial fibrillation in ischemic stroke of unknown cause

Circulation

A survey of atrial fibrillation in general practice: the West Birmingham Atrial Fibrillation Project

Br J Gen Pract

Epidemiologic features of chronic atrial fibrillation: the Framingham study

N Engl J Med

European ancestry as a risk factor for atrial fibrillation in African Americans

Circulation

WHO regional offices. WHO website

Secular trends in prevalence and incidence of atrial fibrillation and associated factors in a Japanese rural population [in Japanese]

Nippon Koshu Eisei Zasshi

Retrospective investigation of hospitalized patients with atrial fibrillation in mainland China

Chin Med J (Engl)

Epidemiology of atrial fibrillation among Qatari patients admitted with various cardiovascular disorder. A population-based study

Saudi Med J

Characteristics of hospitalized patients with atrial fibrillation in Taiwan: a nationwide observation

Am J Med

Electrocardiographic manifestations of healthy residents of a tribal Himalayan village

J Assoc Physicians India

The Avoid Stroke as Soon as Possible (ASAP) general practice stroke audit

Med J Aust

Prevalence of atrial fibrillation in community-dwelling Japanese aged 40 years or older in Japan: analysis of 41,436 non-employee residents in Kurashiki-city

Circ J

Value of plasma B type natriuretic peptide measurement for heart disease screening in a Japanese population

Heart

Original Research
Cardiovascular Disease
Featured
The Global Burden of Atrial Fibrillation and Stroke: A Systematic Review of the Epidemiology of Atrial Fibrillation in Regions Outside North America and Europe