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
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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For editorial comment see page 1368
Funding/Support: Funding for the systematic literature review was provided by Bayer Healthcare AG.
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