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

Joseph PG 1 , Healey JS 1 , Raina P 2 , Connolly SJ 1 , Ibrahim Q 1 , Gupta R 3 Show all authors , Avezum A 4 , Dans AL 5 , Lopez-Jaramillo P 6 , Yeates K 7 , Teo K 1 , Douma R 1 , Bahonar A 8 , Chifamba J 9 , Lanas F 10 , Dagenais GR 11 , Lear SA 12 , Kumar R 13 , Kengne AP 14 , Keskinler M 15 , Mohan V 16 , Mony P 17 , Alhabib KF 18 , Huisman H 19 , Iype T 20 , Zatonska K 21 , Ismail R 22 , Kazmi K 23 , Rosengren A 24 , Rahman O 25 , Yusufali A 26 , Wei L 27 , Orlandini A 28 , Islam S 1 , Rangarajan S 1 , Yusuf S 1 , PURE Investigators

Affiliations 

  • 1 Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
  • 2 Canadian Longitudinal Study of Aging, McMaster University, Hamilton, Ontario, Canada
  • 3 Eternal Heart Care Centre and Research Institute, India
  • 4 Hospital Alemão Oswaldo Cruz and UNISA, São Paulo, Brazil
  • 5 Philippines General Hospital, Manila, Philippines
  • 6 Masira Research Institute, Universidad de Santander (UDES), Bucaramanga, Colombia
  • 7 Queen's University, Kingston, Canada
  • 8 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  • 9 University of Zimbabwe, Department Of Physiology, Harare, Zimbabwe
  • 10 Universidad de La Frontera, Temuco, Chile
  • 11 Université Laval, Quebec, Canada
  • 12 Simon Fraser University, Burnaby, Canada
  • 13 Post Graduate Institute of Medical Education and Research (PGIMER) School of Public Health, Chandigarh, India
  • 14 South African Medical Research Council, Pietermaritzburg, South Africa
  • 15 Istanbul Goztepe Training and Research Hospital, Istanbul, Turkey
  • 16 Madras Diabetes Research Foundation, Chennai, India
  • 17 St John's Medical College & Research Institute, Bengaluru, India
  • 18 Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  • 19 Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
  • 20 Government Medical College, Kerala, India
  • 21 Department of Social Medicine, Medical University of Wroclaw, Wroclaw, Poland
  • 22 Universiti Kebangsaan, Selangor, Malaysia
  • 23 Aga Khan University, Karachi, Pakistan
  • 24 Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
  • 25 Independent University, Dhaka, Bangladesh
  • 26 Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
  • 27 Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
  • 28 Estudios Clínicos Latinoamérica (ECLA), Santa Fe, Argentina
Cardiovasc Res, 2021 05 25;117(6):1523-1531.
PMID: 32777820 DOI: 10.1093/cvr/cvaa241

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 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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