50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study

Renate B Schnabel; Xiaoyan Yin; Philimon Gona; Martin G Larson; Alexa S Beiser; David D McManus; Christopher Newton-Cheh; Steven A Lubitz; Jared W Magnani; Patrick T Ellinor; Sudha Seshadri; Philip A Wolf; Ramachandran S Vasan; Emelia J Benjamin; Daniel Levy

doi:10.1016/S0140-6736(14)61774-8

50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study

Lancet. 2015 Jul 11;386(9989):154-62. doi: 10.1016/S0140-6736(14)61774-8. Epub 2015 May 7.

Authors

Affiliations

¹ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Deutsches Zentrum fuer Herz-Kreislauf-Forschung, University Heart Center, Department of General and Interventional Cardiology, Hamburg, Germany. Electronic address: r.schnabel@uke.de.
² National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
³ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Division of Biostatistics and Health Services Research, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Boston, MA, USA.
⁴ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; Department of Mathematics and Statistics, Boston University, Boston, MA, USA.
⁵ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; Neurology Department, School of Medicine, Boston University, Boston, MA, USA.
⁶ Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Boston, MA, USA.
⁷ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Program in Medical Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA.
⁸ Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁹ Cardiology Section, School of Medicine, Boston University, Boston, MA, USA.
¹⁰ Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Program in Medical Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA.
¹¹ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA.
¹² National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Neurology Department, School of Medicine, Boston University, Boston, MA, USA; Preventive Medicine Section, School of Medicine, Boston University, Boston, MA, USA.
¹³ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Whitaker Cardiovascular Institute, School of Medicine, Boston University, Boston, MA, USA; Evans Memorial Medicine Department, School of Medicine, Boston University, Boston, MA, USA; Cardiology Section, School of Medicine, Boston University, Boston, MA, USA; Preventive Medicine Section, School of Medicine, Boston University, Boston, MA, USA.
¹⁴ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Whitaker Cardiovascular Institute, School of Medicine, Boston University, Boston, MA, USA; Evans Memorial Medicine Department, School of Medicine, Boston University, Boston, MA, USA; Cardiology Section, School of Medicine, Boston University, Boston, MA, USA; Preventive Medicine Section, School of Medicine, Boston University, Boston, MA, USA.
¹⁵ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Preventive Medicine Section, School of Medicine, Boston University, Boston, MA, USA; Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.

Abstract

Background: Comprehensive long-term data on atrial fibrillation trends in men and women are scant. We aimed to provide such data through analysis of the Framingham cohort over 50 years.

Methods: We investigated trends in incidence, prevalence, and risk factors for atrial fibrillation and its association with stroke and mortality after onset in 9511 participants enrolled in the Framingham Heart Study between 1958 and 2007. We analysed trends within 10 year groups (1958-67, 1968-77, 1978-87, 1988-97, and 1998-2007), stratified by sex.

Findings: During 50 years of observation (202,417 person-years), 1544 cases of new-onset atrial fibrillation occurred (of whom 723 [47%] were women). Between 1958-67 and 1998-2007, age-adjusted prevalence of atrial fibrillation quadrupled from 20·4 to 96·2 cases per 1000 person-years in men and from 13·7 to 49·4 cases per 1000 person-years in women; age-adjusted incidence increased from 3·7 to 13·4 new cases per 1000 person-years in men and from 2·5 to 8·6 new cases per 1000 person-years in women (ptrend<0·0001 for all comparisons). For atrial fibrillation diagnosed by electrocardiograph (ECG) during routine Framingham examinations, age-adjusted prevalence per 1000 person-years increased (12·6 in 1958-67 to 25·7 in 1998-2007 in men, ptrend=0·0007; 8·1 to 11·8 in women, ptrend=0·009). However, age-adjusted incidence of atrial fibrillation by Framingham Heart Study ECGs did not change significantly with time. Although the prevalence of most risk factors changed over time, their associated hazards for atrial fibrillation changed little. Multivariable-adjusted proportional hazards models revealed a 74% (95% CI 50-86%) decrease in stroke (hazards ratio [HR] 3·77, 95% CI 1·98-7·20 in 1958-1967 compared with 1998-2007; ptrend=0·0001) and a 25% (95% CI -3-46%) decrease in mortality (HR 1·34, 95% CI 0·97-1·86 in 1958-1967 compared with 1998-2007; ptrend=0·003) in 20 years following atrial fibrillation onset.

Interpretation: Trends of increased incidence and prevalence of atrial fibrillation in the community were probably partly due to enhanced surveillance. Measures are needed to enhance early detection of atrial fibrillation, through increased awareness coupled with targeted screening programmes and risk factor-specific prevention.

Funding: NIH, NHLBI, NINDS, Deutsche Forschungsgemeinschaft.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Age Distribution
Aged
Aged, 80 and over
Atrial Fibrillation / epidemiology*
Atrial Fibrillation / etiology
Cohort Studies
Electrocardiography
Female
Humans
Incidence
Male
Middle Aged
Mortality / trends
Prevalence
Risk Factors
Sex Distribution
Stroke / epidemiology
Stroke / etiology
United States / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding