An epidemic of atrial fibrillation?

Abstract

This editorial refers to ‘Trends in the incidence and prevalence of atrial fibrillation in Iceland and future projections’ by H. Stefansdottir et al. , on page 1110. Numerous risk factors pre-dispose to atrial fibrillation (AF), namely, hypertension, heart failure, increasing age, diabetes mellitus, and vascular disease.1 Due to the ageing population and the increasing prevalence of the known risk factors for AF,2 it may be relevant to investigate whether the incidence and prevalence of AF is increasing as well. Indeed, recently Huxley et al .2 reported that more than half of the incident AF cases are due to known cardiovascular risk factors, implying that firstly, the incidence of AF will rise with the increasing prevalence of known risk factors; secondly, that other factors, possibly genetic, may have a greater role in the aetiology of AF; and thirdly, it may be possible to avoid a large proportion of the incident AF cases if the prevalence of the already-known risk factors are reduced. Stefansdottir et al .3 examined trends in the incidence and prevalence of AF in Iceland among all citizens in the capital, Reykjavik, and both hospital admissions and outpatients AF diagnoses were included. The present study found that the incidence of AF increased significantly in women (by 0.9% per year) but not in men (by 0.1% per year) in the study period, 1991–2008.3 The prevalence of AF was projected to increase from 2.0% in 2008 to 4.3% in 2050 and with the expected increase in population size, this would result in a three-fold increase in the number of patients with AF (from 4495 …