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Global Variations in the Prevalence, Treatment, and Impact of Atrial Fibrillation in a Multi-National Cohort of 153 152 Middle-Aged Individuals Publisher Pubmed



Joseph PG1 ; Healey JS1 ; Raina P2 ; Connolly SJ1 ; Ibrahim Q1 ; Gupta R3 ; Avezum A4 ; Dans AL5 ; Lopezjaramillo P6 ; Yeates K7 ; Teo K1 ; Douma R1 ; Bahonar A8 ; Chifamba J9 Show All Authors
Authors
  1. Joseph PG1
  2. Healey JS1
  3. Raina P2
  4. Connolly SJ1
  5. Ibrahim Q1
  6. Gupta R3
  7. Avezum A4
  8. Dans AL5
  9. Lopezjaramillo P6
  10. Yeates K7
  11. Teo K1
  12. Douma R1
  13. Bahonar A8
  14. Chifamba J9
  15. Lanas F10
  16. Dagenais GR11
  17. Lear SA12
  18. Kumar R13
  19. Kengne AP14
  20. Keskinler M15
  21. Mohan V16
  22. Mony P17
  23. Alhabib KF18
  24. Huisman H19, 20
  25. Iype T21
  26. Zatonska K22
  27. Ismail R23
  28. Kazmi K24
  29. Rosengren A25
  30. Rahman O26
  31. Yusufali A27
  32. Wei L28
  33. Orlandini A29
  34. Islam S1
  35. Rangarajan S1
  36. Yusuf S1
Show Affiliations
Authors Affiliations
  1. 1. Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, L8L 2X2, ON, Canada
  2. 2. Canadian Longitudinal Study of Aging, McMaster University, Hamilton, ON, Canada
  3. 3. Eternal Heart Care Centre, Research Institute, India
  4. 4. Hospital Alemao Oswaldo Cruz, Unisa, Sao Paulo, Brazil
  5. 5. Philippines General Hospital, Manila, Philippines
  6. 6. Masira Research Institute, Universidad de Santander (UDES), Bucaramanga, Colombia
  7. 7. Queen's University, Kingston, Canada
  8. 8. Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  9. 9. University of Zimbabwe, Department of Physiology, Harare, Zimbabwe
  10. 10. Universidad de la Frontera, Temuco, Chile
  11. 11. Universite Laval, QC, Canada
  12. 12. Simon Fraser University, Burnaby, Canada
  13. 13. Post Graduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
  14. 14. South African Medical Research Council, Pietermaritzburg, South Africa
  15. 15. Istanbul Goztepe Training and Research Hospital, Istanbul, Turkey
  16. 16. Madras Diabetes Research Foundation, Chennai, India
  17. 17. St John's Medical College and Research Institute, Bengaluru, India
  18. 18. Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  19. 19. Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
  20. 20. South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
  21. 21. Government Medical College, Kerala, India
  22. 22. Department of Social Medicine, Medical University of Wroclaw, Wroclaw, Poland
  23. 23. Universiti Kebangsaan, Selangor, Malaysia
  24. 24. Aga Khan University, Karachi, Pakistan
  25. 25. Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
  26. 26. Independent University, Dhaka, Bangladesh
  27. 27. Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
  28. 28. Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
  29. 29. Estudios Clinicos Latinoamerica (ECLA), Santa Fe, Argentina

Source: Cardiovascular Research Published:2021


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. © 2020 Published on behalf of the European Society of Cardiology. All rights reserved.
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