Skip to main content

Epidemiology, Burden and Unmet Needs in Atrial Fibrillation

  • Chapter
  • First Online:
Atrial Fibrillation Therapy

Abstract

Atrial fibrillation (AF) is an arrhythmia characterized by chaotic electrical activity in the atria, which causes asynchrony of atrial fibers excitation and contraction. Thus, the organized contractile capacity of the atrium for filling the ventricles is lost which diminishes the ventricular ejection, as well as, auricular blood stasis and turbulent flow favors thrombosis and consequent thromboembolism may develop. Therefore, this arrhythmia has an important clinical impact. This chapter summarizes the several unmet needs in AF, which still constitute a challenge for patients, physicians and health care managers because its medical, social and economic impact probably will worsen over the next decades. Therefore, research and future knowledge of AF will play a major role for modern societies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Barrios V, Calderón A, Escobar C, de la Figuera M; en representación del Grupo de Atención Primaria de la sección de Cardiología Clínica de la Sociedad Española de Cardiología. Patients with atrial fibrilladion in a primary care setting: Val-FAAP Study. Rev Esp Cardiol. 2012;65(1):47–53.

    Google Scholar 

  2. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study. JAMA. 2001;285:2370–5.

    Article  PubMed  CAS  Google Scholar 

  3. Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP, Seward JB, Tsang TS. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114(2):119–25.

    Article  PubMed  Google Scholar 

  4. López Soto A, Formiga F, Bosch X, García Alegría J; en representación de los investigadores del estudio ESFINGE. Prevalence of atrial fibrillation and related factors in hospitalizad old patients: ESFINGE study. Med Clin (Barc). 2011:138(6):231–7.

    Google Scholar 

  5. Navarro JL, Cesar JM, Fernández MA, Fontcuberta J, Reverter JC, Gol-Freixa J. Morbidity and mortality in patients treated with oral anticoagulants. Rev Esp Cardiol. 2007;60(12):1226–32.

    Article  PubMed  Google Scholar 

  6. Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch Intern Med. 1994;154:1449–57.

    Article  Google Scholar 

  7. Flegel KM, Shipley MJ, Rose G. Risk of stroke in non-rheumatic atrial fibrillation. Lancet. 1987;1(8537):526–9.

    Article  PubMed  CAS  Google Scholar 

  8. Krahn AD, Manfreda J, Tate RB, Mathewson FA, Cuddy TE. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba follow-up study. Am J Med. 1995;98:476–84.

    Article  PubMed  CAS  Google Scholar 

  9. Benjamin E, Wolff P, D’Agostino R, Silbershatz H, Kannel W, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998;98:946–52.

    Article  PubMed  CAS  Google Scholar 

  10. Stewart S, Hart CL, Hole DJ, McMurray JJ. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med. 2002;113(5):359–64.

    Article  PubMed  Google Scholar 

  11. Vidaillet H, Granada JF, Chyou PH, Maassen K, Ortiz M, Pulido JN, et al. A population-based study of mortality among patients with atrial fibrillation or flutter. Am J Med. 2002;113:365–70.

    Article  PubMed  Google Scholar 

  12. Benjamin E, Levy D, Vaziri S, D’Agostino R, Belanger A, Wolf P. Independent risk factors for atrial fibrillation in a population-based cohort. JAMA. 2004;271:840–4.

    Article  Google Scholar 

  13. Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation – executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with atrial fibrillation). Eur Heart J. 2006;27:1979–2030.

    Article  PubMed  Google Scholar 

  14. Kelly-Hayes M, Beiser A, Kase CS, Scaramucci A, D’Agostino RB, Wolf PA. The influence of gender and age on disability following ischemic stroke: the Framingham study. J Stroke Cerebrovasc Dis. 2003;12(3):119–26.

    Article  PubMed  Google Scholar 

  15. Camm JA, Kirchhof P, Lip GYH, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, DeCaterina R, DeSutter J, Goette A, Gorenek B, Heldal M, Hohnloser SH, Kolh P, LeHeuzey JY, Ponikowski P, Rutten FR. Guidelines for the management of atrial fibrillation. Eur Heart J. 2010;31:2369–429.

    Article  PubMed  Google Scholar 

  16. Knecht S, Oelschlager C, Duning T, Lohmann H, Albers J, Stehling C, Heindel W, Breithardt G, Berger K, Ringelstein EB, Kirchhof P, Wersching H. Atrial fibrillation in stroke-free patients is associated with memory impairment and hippocampal atrophy. Eur Heart J. 2008;29:2125–32.

    Article  PubMed  Google Scholar 

  17. Lin HJ, Wolf PA, Kelly-Hayes M, Beiser AS, Kase CS, Benjamin EJ, D’Agostino RB. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27:1760–4.

    Article  PubMed  CAS  Google Scholar 

  18. Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol. 2011;57(11):e101–9.

    Article  PubMed  Google Scholar 

  19. Camm AJ, Lip GYH, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. Eur Heart J. 2012. doi:10.1093/eurheartj/ehs253.

  20. Wann LS, Curtis AB, Ellenbogen KA, Estes NA 3rd, Ezekowitz MD, Jackman WM, January CT, Lowe JE, Page RL, Slotwiner DJ, Stevenson WG, Tracy CM, Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Heuzey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS, Jacobs AK, Anderson JL, Albert N, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson WG, Yancy CW; American College of Cardiology Foundation/American Heart Association Task Force. 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (update on dabigatran). A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011;123:1144–50.

    Google Scholar 

  21. You JJ, Singer DE, Howard PA, Lane DA, Eckman MH, Fang MC, Hylek EM, Schulman S, Go AS, Hughes M, Spencer FA, Manning WJ, Halperin JL, Lip GY; American College of Chest Physicians. Antithrombotic therapy for atrial fibrillation: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141:e531S–75.

    Google Scholar 

  22. Skanes AC, Healey JS, Cairns JA, Dorian P, Gillis AM, McMurtry MS, Mitchell LB, Verma A, Nattel S; Canadian Cardiovascular Society Atrial Fibrillation Guidelines Committee. Focused 2012 update of the Canadian Cardiovascular Society Atrial Fibrillation Guidelines: recommendations for stroke prevention and rate/rhythm control. Can J Cardiol. 2012;28:125–36.

    Google Scholar 

  23. Campuzano O, Brugada R. Genetics of familial atrial fibrillation. Europace. 2009;11(10):1267–71.

    Article  PubMed  Google Scholar 

  24. Bayés de Luna A. Clinical arrhythmology. Wiley-Blackwell; 2011.

    Google Scholar 

  25. Tsadok MA, Jackevicius CA, Essebag V, Eisenberg MJ, Rahme E, Humphries KH, Tu JV, Behlouli H, Pilote L. Rhythm versus rate control therapy and subsequent stroke or transient ischemic attack in patients with atrial fibrillation. Circulation. 2012;126:2680–7.

    Article  PubMed  Google Scholar 

  26. Arbelo E, Brugada J, Hindricks G, Maggioni A, Tavazzi L, Vardas P, Anselme F, Inama G, Jais P, Kalarus Z, Kautzner J, Lewalter T, Mairesse G, Perez-Villacastin J, Riahi S, Taborsky M, Theodorakis G, Trines S; on behalf of the Atrial Fibrillation Ablation Pilot Study Investigators. ESC-EURObservational research programme: the atrial fibrillation ablation pilot study, conducted by the European Heart Rhythm Association. Europace 2012;14:1094–103.

    Google Scholar 

  27. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Natale A, Packer D, Skanes A, Ambrogi F, Biganzoli E. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3:32–8.

    Article  PubMed  Google Scholar 

  28. Shah RU, Freeman JV, Shilane D, Wang PJ, Go AS, Hlatky MA. Procedural complications, rehospitalizations, and repeat procedures after catheter ablation for atrial fibrillation. J Am Coll Cardiol. 2012;59:143–9.

    Article  PubMed  Google Scholar 

  29. Herrera Siklódy C, Deneke T, Hocini M, Lehrmann H, Shin DI, Miyazaki S, Henschke S, Fluegel P, Schiebeling-Römer J, Bansmann PM, Bourdias T, Dousset V, Haıssaguerre M, Arentz T. Incidence of asymptomatic intracranial embolic events after pulmonary vein isolation: comparison of different atrial fibrillation ablation technologies in a multicenter study. J Am Coll Cardiol. 2011;58:681–8.

    Article  PubMed  Google Scholar 

  30. Di Biase L, Burkhardt JD, Mohanty P, Sanchez J, Horton R, Gallinghouse GJ, Lakkireddy D, Verma A, Khaykin Y, Hongo R, Hao S, Beheiry S, Pelargonio G, Dello Russo A, Casella M, Santarelli P, Santangeli P, Wang P, Al-Ahmad A, Patel D, Themistoclakis S, Bonso A, Rossillo A, Corrado A, Raviele A, Cummings JE, Schweikert RA, Lewis WR, Natale A. Periprocedural stroke and management of major bleeding complications in patients undergoing catheter ablation of atrial fibrillation: the impact of periprocedural therapeutic international normalized ratio. Circulation. 2010;121:2550–6.

    Article  PubMed  Google Scholar 

  31. Gaita F, Leclercq JF, Schumacher B, Scaglione M, Toso E, Halimi F, Schade A, Froehner S, Ziegler V, Sergi D, Cesarani F, Blandino A. Incidence of silent cerebral thromboembolic lesions after atrial fibrillation ablation may change according to technology used: comparison of irrigated radiofrequency, multipolar nonirrigated catheter and cryoballoon. J Cardiovasc Electrophysiol. 2011;22:961–8.

    Article  PubMed  Google Scholar 

  32. Ouyang F, Tilz R, Chun J, Schmidt B, Wissner E, Zerm T, Neven K, Ko ̈ktu ̈rk B, Konstantinidou M, Metzner A, Fuernkranz A, Kuck KH. Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow- up. Circulation. 2010;122:2368–77.

    Article  PubMed  Google Scholar 

  33. Tzou WS, Marchlinski FE, Zado ES, Lin D, Dixit S, Callans DJ, Cooper JM, Bala R, Garcia F, Hutchinson MD, Riley MP, Verdino R, Gerstenfeld EP. Long-term outcome after successful catheter ablation of atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3:237–42.

    Article  PubMed  Google Scholar 

  34. Arya A, Hindricks G, Sommer P, Huo Y, Bollmann A, Gaspar T, Bode K, Husser D, Kottkamp H, Piorkowski C. Long-term results and the predictors of outcome of catheter ablation of atrial fibrillation using steerable sheath catheter navigation after single procedure in 674 patients. Europace. 2010;12:173–80.

    Article  PubMed  Google Scholar 

  35. Weerasooriya R, Khairy P, Litalien J, Macle L, Hocini M, Sacher F, Lellouche N, Knecht S, Wright M, Nault I, Miyazaki S, Scavee C, Clementy J, Haissaguerre M, Jais P. Catheter ablation for atrial fibrillation: are results maintained at 5 years of follow-up? J Am Coll Cardiol. 2011;57:160–6.

    Article  PubMed  Google Scholar 

  36. Cosedis Nielsen J, Johannessen A, Raatikainen P, Hindricks G, Walfridsson H, Kongstad O, Pehrson S, Englund A, Hartikainen J, Mortensen LS, Hansen PS. A randomized comparison of radiofrequency ablation and antiarrhythmia drug therapy as first line treatment in paroxysmal atrial fibrillation. N Engl J Med. 2012;367(17):1587–95.

    Article  PubMed  Google Scholar 

  37. Wazni OM, Marrouche NF, Martin DO, Verma A, Bhargava M, Saliba W, Bash D, Schweikert R, Brachmann J, Gunther J, Gutleben K, Pisano E, Potenza D, Fanelli R, Raviele A, Themistoclakis S, Rossillo A, Bonso A, Natale A. Radiofrequency ablation vs antiarrhythmic drugs as firstline treatment of symptomatic atrial fibrillation: a randomized trial. JAMA. 2005;293:2634–40.

    Article  PubMed  CAS  Google Scholar 

  38. Boersma LV, Castella M, van Boven W, Berruezo A, Yilmaz A, Nadal M, Sandoval E, Calvo N, Brugada J, Kelder J, Wijffels M, Mont L. Atrial fibrillation catheter ablation vs. surgical ablation treatment (FAST): a 2-center randomized clinical trial. Circulation. 2012;125:23–30.

    Article  PubMed  Google Scholar 

  39. Stroke in AF Working Group. Independent predictors of stroke in patients with atrial fibrillation: a systematic review. Neurology. 2007;69:546–54.

    Article  Google Scholar 

  40. Hughes M, Lip GY. Stroke and thromboembolism in atrial fibrillation: a systematic review of stroke risk factors, risk stratification schema and cost effectiveness data. Thromb Haemost. 2008;99:295–304.

    PubMed  CAS  Google Scholar 

  41. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest. 2010;137:263–72.

    Article  PubMed  Google Scholar 

  42. Gage BF, Yan Y, Milligan PE, Waterman AD, Culverhouse R, Rich MW, Radford MJ. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J. 2006;151:713–9.

    Article  PubMed  Google Scholar 

  43. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user- friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138:1093–100.

    Article  PubMed  Google Scholar 

  44. Fang MC, Go AS, Chang Y, Borowsky LH, Pomernacki NK, Udaltsova N, Singer DE. A new risk scheme to predict warfarin-associated hemorrhage: the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) study. J Am Coll Cardiol. 2011;58:395–401.

    Article  PubMed  Google Scholar 

  45. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146:857–67.

    Article  PubMed  Google Scholar 

  46. Odén A, Fahlén M, Hart RG. Optimal INR for prevention of stroke and death in atrial fibrillation: a critical appraisal. Thromb Res. 2006;117(5):493–9.

    Article  PubMed  Google Scholar 

  47. Fang MC, Chang Y, Hylek EM, Rosand J, Greenberg SM, Go AS, Singer DE. Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation. Ann Intern Med. 2004;141(10):745–52.

    Article  PubMed  Google Scholar 

  48. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139–51.

    Article  PubMed  CAS  Google Scholar 

  49. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883–91.

    Article  PubMed  CAS  Google Scholar 

  50. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981–92.

    Article  PubMed  CAS  Google Scholar 

  51. Banerjee A, Lane DA, Torp-Pedersen C, Lip GY. Net clinical benefit of new oral anticoagulants (dabigatran, rivaroxaban, apixaban) vs. no treatment in a ‘real world’ atrial fibrillation population: a modelling analysis based on a nationwide cohort study. Thromb Haemost. 2012;107:584–9.

    Article  PubMed  CAS  Google Scholar 

  52. Maggioni AD. Acute coronary syndrome in patients with atrial fibrillation. Circulation. 2012;126:1176–8.

    Article  PubMed  Google Scholar 

  53. De Caterina R, Husted S, Wallentin L, Andreotti F, Arnesen H, Bachman F, Baigent C, Hubert K, Jespersen J, Kristensen SD, Lip GYH, Morais J, Rasmussen LH, Siegbahn A, Verheugt FWA, Weitz JI. New oral anticoagulants in atrial fibrillation and acute coronary syndromes. J Am Coll Cardiol. 2012;59:1413–25.

    Article  PubMed  Google Scholar 

  54. Lip GY, Huber K, Andreotti F, Arnesen H, Airaksinen KJ, Cuisset T, Kirchhof P, Marín F. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary intervention/stenting. Thromb Haemost. 2010;103:13–28.

    Article  PubMed  CAS  Google Scholar 

  55. Lamberts M, Olesen JB, Ruwald MH, Hansen CM, Karasoy D, Kristensen SL, Køber L, Torp-Pedersen C, Gislason GH, Hansen ML. Bleeding after initiation of multiple antithrombotic drugs, including triple therapy, in atrial fibrillation patients following myocardial infarction and coronary intervention: a nationwide cohort study. Circulation. 2012;126:1185–93.

    Article  PubMed  Google Scholar 

  56. Sorensen SV, Kansal AR, Connolly S, Peng S, Linnehan J, Bradley-Kennedy C, Plumb JM. Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolismo in atrial fibrillation: a Canadian payer perspective. Thromb Haemost. 2011;105(5):908–19.

    Article  PubMed  CAS  Google Scholar 

  57. Pink J, Lane S, Pirmohamed M, Hughes DA. Dabigatran etexilate versus warfarin in Management of non-valvular atrial fibrillation in UK context: quantitative benefit-harm and economic analyses. BMJ. 2011;343:d6333.

    Article  PubMed  Google Scholar 

  58. Shah SV, Gage BF. Cost-effectiveness of dabigatran for stroke prophylaxis in atrial fibrillation. Circulation. 2011;123(22):2562–70.

    Article  PubMed  Google Scholar 

  59. Freeman JV, Zhu RP, Owens DK, Garber AM, Hutton DW, Go AS, Wang PJ, Turakhia MP. Cost-effectiveness of dabigatran compared with warfarin for stroke prevention in atrial fibrillation. Ann Intern Med. 2011;154(1):1–11.

    Article  PubMed  Google Scholar 

  60. Lee S, Anglade MW, Pisacane R, Kluger J, Coleman CI. Cost-effectiveness of rivaroxaban compared to warfarin for stroke prevention in atrial fibrillation. Am J Cardiol. 2012;110:845–51.

    Article  PubMed  CAS  Google Scholar 

  61. González-Juanatey JR, Alvarez-Sabín J, Lobos JM, Martínez-Rubio A, Reverter JC, Oyagüez I, González-Rojas N, Becerra V. Cost-effectiveness of dabigatran for stroke prevention in non-valvular atrial fibrillation in Spain. Rev Esp Cardiol. 2012;65(10):901–10.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Antoni Martínez-Rubio MD, PhD, FESC, FACC .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Martínez-Rubio, A., Soldevila, J.G., de Luna, A.B. (2014). Epidemiology, Burden and Unmet Needs in Atrial Fibrillation. In: Dan, GA., Bayés de Luna, A., Camm, J. (eds) Atrial Fibrillation Therapy. Current Cardiovascular Therapy. Springer, London. https://doi.org/10.1007/978-1-4471-5475-4_1

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-5475-4_1

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5474-7

  • Online ISBN: 978-1-4471-5475-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics