Abstract
BACKGROUND: Understanding trends in atrial fibrillation (AF) and atrial flutter (AFL) is crucial for effective prevention. This study quantifies the burden and identifies key risk factors for AF/AFL across 204 countries and territories from 1990 to 2021. METHODS: Using data from the Global Burden of Disease (GBD) study 2021, we employed average annual percentage change (AAPC) and Bayesian Age Period Cohort (BAPC) modelling to assess trends and future projections, with a focus on disparities across Socio-Demographic Index (SDI) levels. RESULTS: In 2021, AF/AFL remained the most common arrhythmia globally, with a prevalence of 52.55 million, 8.36 million disability-adjusted life years (DALYs), and 0.34 million deaths. For each 0.1 increase in SDI, age-standardized mortality rates increased by 4.94%, DALYs by 2.56%, and prevalence rates by 2.40%, highlighting the significant impact of socioeconomic development on AF/AFL burden. AAPC analysis indicated slight increases in deaths, prevalence, and DALYs, along with a decline in incidence, reflecting the impact of public health strategies. However, significant inequalities were observed across SDI levels, with a higher burden in high-SDI regions because of aging populations and improved detection, whereas lower SDI regions faced higher age-standardized mortality rates because of resource constraints. CONCLUSIONS: By 2035, we project a 4.07% increase in incidence despite a 6.84% decrease in mortality. Nearly one-half of the AF/AFL burden is linked to modifiable risk factors, underscoring the importance of tailored prevention strategies and improved health care access, especially in lower SDI countries, to mitigate rising disease rates and reduce health care disparities.