Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals

Philip G. Joseph; Jeffrey S. Healey; Parminder Raina; Stuart J. Connolly; Quazi Ibrahim; Rajeev Gupta; Alvaro Avezum; Antonio L. Dans; Patricio Lopez-Jaramillo; Karen Yeates; Koon Teo; Reuben Douma; Ahmad Bahonar; Jephat Chifamba; Fernando Lanas; Gilles R. Dagenais; Scott A. Lear; Rajesh Kumar; Andre P. Kengne; Mirac Keskinler; Viswanathan Mohan; Prem Mony; Khalid F. Alhabib; Hugo Huisman; Thomas Iype; Katarzyna Zatonska; Rosnah Ismail; Khawar Kazmi; Annika Rosengren; Omar Rahman; Afzalhussein Yusufali; Li Wei; Andres Orlandini; Shofiqul Islam; Sumathy Rangarajan; Salim Yusuf

doi:10.1093/cvr/cvaa241

Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals

Philip G. Joseph, Jeffrey S. Healey, Parminder Raina, Stuart J. Connolly, Quazi Ibrahim, Rajeev Gupta, Alvaro Avezum, Antonio L. Dans, Patricio Lopez-Jaramillo, Karen Yeates, Koon Teo, Reuben Douma, Ahmad Bahonar, Jephat Chifamba, Fernando Lanas, Gilles R. Dagenais, Scott A. Lear, Rajesh Kumar, Andre P. Kengne, Mirac KeskinlerViswanathan Mohan, Prem Mony, Khalid F. Alhabib, Hugo Huisman, Thomas Iype, Katarzyna Zatonska, Rosnah Ismail, Khawar Kazmi, Annika Rosengren, Omar Rahman, Afzalhussein Yusufali, Li Wei, Andres Orlandini, Shofiqul Islam, Sumathy Rangarajan, Salim Yusuf

Department of Medicine, Medical College, Pakistan

Research output: Contribution to journal › Article › peer-review

36 Citations (Scopus)

Abstract

Aims: To compare the prevalence of electrocardiogram (ECG)-documented atrial fibrillation (or flutter) (AF) across eight regions of the world, and to examine antithrombotic use and clinical outcomes. Methods and results: Baseline ECGs were collected in 153 152 middle-aged participants (ages 35-70 years) to document AF in two community-based studies, spanning 20 countries. Medication use and clinical outcome data (mean follow-up of 7.4 years) were available in one cohort. Cross-sectional analyses were performed to document the prevalence of AF and medication use, and associations between AF and clinical events were examined prospectively. Mean age of participants was 52.1 years, and 57.7% were female. Age and sex-standardized prevalence of AF varied 12-fold between regions; with the highest in North America, Europe, China, and Southeast Asia (270-360 cases per 100 000 persons); and lowest in the Middle East, Africa, and South Asia (30-60 cases per 100 000 persons) (P < 0.001). Compared with low-income countries (LICs), AF prevalence was 7-fold higher in middle-income countries (MICs) and 11-fold higher in high-income countries (HICs) (P < 0.001). Differences in AF prevalence remained significant after adjusting for traditional AF risk factors. In LICs/MICs, 24% of participants with AF and a CHADS2 score ≥1 received antithrombotic therapy, compared with 85% in HICs. AF was associated with an increased risk of stroke [hazard ratio (HR) 2.29; 95% confidence interval (CI) 1.49-3.52] and death (HR 2.97; 95% CI 2.25-3.93); with similar rates in different countries grouped by income level. Conclusions: Large variations in AF prevalence occur in different regions and countries grouped by income level, but this is only partially explained by traditional AF risk factors. Antithrombotic therapy is infrequently used in poorer countries despite the high risk of stroke associated with AF.

Original language	English
Pages (from-to)	1523-1531
Number of pages	9
Journal	Cardiovascular Research
Volume	117
Issue number	6
DOIs	https://doi.org/10.1093/cvr/cvaa241
Publication status	Published - 1 Jun 2021

Keywords

Atrial fibrillation
CLSA
Epidemiology

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10.1093/cvr/cvaa241

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Joseph, P. G., Healey, J. S., Raina, P., Connolly, S. J., Ibrahim, Q., Gupta, R., Avezum, A., Dans, A. L., Lopez-Jaramillo, P., Yeates, K., Teo, K., Douma, R., Bahonar, A., Chifamba, J., Lanas, F., Dagenais, G. R., Lear, S. A., Kumar, R., Kengne, A. P., ... Yusuf, S. (2021). Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals. Cardiovascular Research, 117(6), 1523-1531. https://doi.org/10.1093/cvr/cvaa241

@article{8c3ac6e6f9234bb481b56ea8f45b9596,

title = "Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals",

abstract = "Aims: To compare the prevalence of electrocardiogram (ECG)-documented atrial fibrillation (or flutter) (AF) across eight regions of the world, and to examine antithrombotic use and clinical outcomes. Methods and results: Baseline ECGs were collected in 153 152 middle-aged participants (ages 35-70 years) to document AF in two community-based studies, spanning 20 countries. Medication use and clinical outcome data (mean follow-up of 7.4 years) were available in one cohort. Cross-sectional analyses were performed to document the prevalence of AF and medication use, and associations between AF and clinical events were examined prospectively. Mean age of participants was 52.1 years, and 57.7% were female. Age and sex-standardized prevalence of AF varied 12-fold between regions; with the highest in North America, Europe, China, and Southeast Asia (270-360 cases per 100 000 persons); and lowest in the Middle East, Africa, and South Asia (30-60 cases per 100 000 persons) (P < 0.001). Compared with low-income countries (LICs), AF prevalence was 7-fold higher in middle-income countries (MICs) and 11-fold higher in high-income countries (HICs) (P < 0.001). Differences in AF prevalence remained significant after adjusting for traditional AF risk factors. In LICs/MICs, 24% of participants with AF and a CHADS2 score ≥1 received antithrombotic therapy, compared with 85% in HICs. AF was associated with an increased risk of stroke [hazard ratio (HR) 2.29; 95% confidence interval (CI) 1.49-3.52] and death (HR 2.97; 95% CI 2.25-3.93); with similar rates in different countries grouped by income level. Conclusions: Large variations in AF prevalence occur in different regions and countries grouped by income level, but this is only partially explained by traditional AF risk factors. Antithrombotic therapy is infrequently used in poorer countries despite the high risk of stroke associated with AF.",

keywords = "Atrial fibrillation, CLSA, Epidemiology",

author = "Joseph, {Philip G.} and Healey, {Jeffrey S.} and Parminder Raina and Connolly, {Stuart J.} and Quazi Ibrahim and Rajeev Gupta and Alvaro Avezum and Dans, {Antonio L.} and Patricio Lopez-Jaramillo and Karen Yeates and Koon Teo and Reuben Douma and Ahmad Bahonar and Jephat Chifamba and Fernando Lanas and Dagenais, {Gilles R.} and Lear, {Scott A.} and Rajesh Kumar and Kengne, {Andre P.} and Mirac Keskinler and Viswanathan Mohan and Prem Mony and Alhabib, {Khalid F.} and Hugo Huisman and Thomas Iype and Katarzyna Zatonska and Rosnah Ismail and Khawar Kazmi and Annika Rosengren and Omar Rahman and Afzalhussein Yusufali and Li Wei and Andres Orlandini and Shofiqul Islam and Sumathy Rangarajan and Salim Yusuf",

year = "2021",

month = jun,

day = "1",

doi = "10.1093/cvr/cvaa241",

language = "English",

volume = "117",

pages = "1523--1531",

journal = "Cardiovascular Research",

issn = "0008-6363",

publisher = "Oxford University Press",

number = "6",

}

Joseph, PG, Healey, JS, Raina, P, Connolly, SJ, Ibrahim, Q, Gupta, R, Avezum, A, Dans, AL, Lopez-Jaramillo, P, Yeates, K, Teo, K, Douma, R, Bahonar, A, Chifamba, J, Lanas, F, Dagenais, GR, Lear, SA, Kumar, R, Kengne, AP, Keskinler, M, Mohan, V, Mony, P, Alhabib, KF, Huisman, H, Iype, T, Zatonska, K, Ismail, R, Kazmi, K, Rosengren, A, Rahman, O, Yusufali, A, Wei, L, Orlandini, A, Islam, S, Rangarajan, S & Yusuf, S 2021, 'Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals', Cardiovascular Research, vol. 117, no. 6, pp. 1523-1531. https://doi.org/10.1093/cvr/cvaa241

TY - JOUR

T1 - Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals

AU - Joseph, Philip G.

AU - Healey, Jeffrey S.

AU - Raina, Parminder

AU - Connolly, Stuart J.

AU - Ibrahim, Quazi

AU - Gupta, Rajeev

AU - Avezum, Alvaro

AU - Dans, Antonio L.

AU - Lopez-Jaramillo, Patricio

AU - Yeates, Karen

AU - Teo, Koon

AU - Douma, Reuben

AU - Bahonar, Ahmad

AU - Chifamba, Jephat

AU - Lanas, Fernando

AU - Dagenais, Gilles R.

AU - Lear, Scott A.

AU - Kumar, Rajesh

AU - Kengne, Andre P.

AU - Keskinler, Mirac

AU - Mohan, Viswanathan

AU - Mony, Prem

AU - Alhabib, Khalid F.

AU - Huisman, Hugo

AU - Iype, Thomas

AU - Zatonska, Katarzyna

AU - Ismail, Rosnah

AU - Kazmi, Khawar

AU - Rosengren, Annika

AU - Rahman, Omar

AU - Yusufali, Afzalhussein

AU - Wei, Li

AU - Orlandini, Andres

AU - Islam, Shofiqul

AU - Rangarajan, Sumathy

AU - Yusuf, Salim

PY - 2021/6/1

Y1 - 2021/6/1

N2 - Aims: To compare the prevalence of electrocardiogram (ECG)-documented atrial fibrillation (or flutter) (AF) across eight regions of the world, and to examine antithrombotic use and clinical outcomes. Methods and results: Baseline ECGs were collected in 153 152 middle-aged participants (ages 35-70 years) to document AF in two community-based studies, spanning 20 countries. Medication use and clinical outcome data (mean follow-up of 7.4 years) were available in one cohort. Cross-sectional analyses were performed to document the prevalence of AF and medication use, and associations between AF and clinical events were examined prospectively. Mean age of participants was 52.1 years, and 57.7% were female. Age and sex-standardized prevalence of AF varied 12-fold between regions; with the highest in North America, Europe, China, and Southeast Asia (270-360 cases per 100 000 persons); and lowest in the Middle East, Africa, and South Asia (30-60 cases per 100 000 persons) (P < 0.001). Compared with low-income countries (LICs), AF prevalence was 7-fold higher in middle-income countries (MICs) and 11-fold higher in high-income countries (HICs) (P < 0.001). Differences in AF prevalence remained significant after adjusting for traditional AF risk factors. In LICs/MICs, 24% of participants with AF and a CHADS2 score ≥1 received antithrombotic therapy, compared with 85% in HICs. AF was associated with an increased risk of stroke [hazard ratio (HR) 2.29; 95% confidence interval (CI) 1.49-3.52] and death (HR 2.97; 95% CI 2.25-3.93); with similar rates in different countries grouped by income level. Conclusions: Large variations in AF prevalence occur in different regions and countries grouped by income level, but this is only partially explained by traditional AF risk factors. Antithrombotic therapy is infrequently used in poorer countries despite the high risk of stroke associated with AF.

AB - Aims: To compare the prevalence of electrocardiogram (ECG)-documented atrial fibrillation (or flutter) (AF) across eight regions of the world, and to examine antithrombotic use and clinical outcomes. Methods and results: Baseline ECGs were collected in 153 152 middle-aged participants (ages 35-70 years) to document AF in two community-based studies, spanning 20 countries. Medication use and clinical outcome data (mean follow-up of 7.4 years) were available in one cohort. Cross-sectional analyses were performed to document the prevalence of AF and medication use, and associations between AF and clinical events were examined prospectively. Mean age of participants was 52.1 years, and 57.7% were female. Age and sex-standardized prevalence of AF varied 12-fold between regions; with the highest in North America, Europe, China, and Southeast Asia (270-360 cases per 100 000 persons); and lowest in the Middle East, Africa, and South Asia (30-60 cases per 100 000 persons) (P < 0.001). Compared with low-income countries (LICs), AF prevalence was 7-fold higher in middle-income countries (MICs) and 11-fold higher in high-income countries (HICs) (P < 0.001). Differences in AF prevalence remained significant after adjusting for traditional AF risk factors. In LICs/MICs, 24% of participants with AF and a CHADS2 score ≥1 received antithrombotic therapy, compared with 85% in HICs. AF was associated with an increased risk of stroke [hazard ratio (HR) 2.29; 95% confidence interval (CI) 1.49-3.52] and death (HR 2.97; 95% CI 2.25-3.93); with similar rates in different countries grouped by income level. Conclusions: Large variations in AF prevalence occur in different regions and countries grouped by income level, but this is only partially explained by traditional AF risk factors. Antithrombotic therapy is infrequently used in poorer countries despite the high risk of stroke associated with AF.

KW - Atrial fibrillation

KW - CLSA

KW - Epidemiology

UR - http://www.scopus.com/inward/record.url?scp=85107090722&partnerID=8YFLogxK

U2 - 10.1093/cvr/cvaa241

DO - 10.1093/cvr/cvaa241

M3 - Article

C2 - 32777820

AN - SCOPUS:85107090722

SN - 0008-6363

VL - 117

SP - 1523

EP - 1531

JO - Cardiovascular Research

JF - Cardiovascular Research

IS - 6

ER -

Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals

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