Global, regional and national burden of atrial fibrillation and flutter attributable to metabolic risks from 1990 to 2021: analysis of data from the global burden of disease study, 2021

Atrial fibrillation (AF) and flutter (AFL) have emerged as the most prevalent types of arrhythmias in recent decades[1]. The medical costs of managing AF and AFL are high, ranging from 450–3000 euros in Europe[2]. Mounting evidence suggests that the increasing burden of AF and AFL is multifactorial and that metabolic syndrome is an important factor. Previous study[3] evaluated the AF/AFL burden attributable to metabolic risk factors from 1990 to 2019; utilizing data from the GBD 2019, however, with advancements in policy and research, the updated assessment and epidemiological data are needed.

We aimed to aimed to summarize the metabolic risk factors that contributed to the AF and AFL burden, considering age and sex differences at the global, regional, and national levels in 2021, and to illustrate the geographic distribution and temporal trends.

Age-standardized disability-adjusted life year(ASRDALY) rates and death rate(ASDR) from 204 countries and territories during 1990-2021 were extracted from the Global Burden of Disease(GBD) 2021 database and the estimated annual percentage changes(EAPCs) were calculated. Uncertainty interval (UI) analysis is used to illustrate the possible heterogeneity from both sampling error and nonsampling variance.

Globally, the ASDR and ASRDALY of AF and AFL attributable to metabolic risks tended to level off(EAPC of 0.07[0.03, 0.11] and 0[-0.02, 0.03]), whereas the high body mass index(BMI) related AF and AFL burden significantly increased. Males had higher ASRDALYs, and females had higher ASDR. In terms of age distribution, AF and AFL deaths and DALYs due to metabolic risks mainly exhibited in the population older than 70 years. The highest increased burden was detected in low-middle socio-demographic index(SDI) regions [EAPC: ASDR 1.39(1.32–1.47); ASRDALY 0.99(0.95–1.02)]. However, the burden in higher SDI regions decreased, and the gap narrowed compared with that in low SDI regions. Regionally, the highest ASDRs of metabolism-related AF and AFL were observed in Australasia, whereas the lowest were observed in Eastern Sub-Saharan Africa. Additionally, from 1990 to 2021, across 21 regions, the ASDR and ASRDALY of AF and AFL due to metabolic risk factors initially increased with increasing SDI and then declined around an SDI of 0.76.

Our study was conducted on a broader scale and over 30 years, using the latest information. The results of our study may benefit policymaking strategies and lifestyle management to reduce the burden of AF and AFL: trends in the global metabolism-related AF and AFL burden shifted from higher SDI regions to lower SDI regions, especially in the elderly population. Healthcare strategies should target screening and managing metabolic risk factors to mitigate the global AF and AFL burden.