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50 Year Trends in Atrial Fibrillation | Journal Scan
Study Questions:
Have the prevalence and prognostic implications of atrial fibrillation (AF) changed over the past 50 years?
Methods:
This was an analysis of 9,511 subjects who participated in the Framingham Heart Study in 1958-2007. The AF incidence, prevalence, risk factors, and associations with mortality and stroke were analyzed in 10-year blocks.
Results:
The age-adjusted prevalence of AF increased from 20.4 to 96.2 cases per 1,000 person-years in men, and from 13.7 to 49.4 cases per 1,000 person-years in women between 1958-1967 and 1998-2007. Between the same years, the AF incidence increased from 3.7 to 13.4 new cases per 1,000 person-years in men, and from 2.5 to 8.6 new cases per 1,000 person-years in women. The AF incidence did not increase significantly when the diagnosis of AF was limited to routine electrocardiograms. The association between various clinical variables (such as age, hypertension, and diabetes) and risk of AF did not change significantly over time. The risk of stroke in subjects with AF decreased by 74% between 1958-1967 and 1998-2007, and the mortality risk decreased by 25% during the same time spans.
Conclusions:
The prevalence and incidence of AF have increased over 50 years of observation in the Framingham population. During the same period of time, the risk of stroke and death associated with AF has gone down.
Perspective:
The fact that the AF incidence did not increase over time when the identification of AF was limited to routine electrocardiograms suggests that the trend towards an increase in AF incidence at least partly is related to enhanced monitoring.
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Cohort Studies, Diabetes Mellitus, Electrocardiography, Electrocardiography, Ambulatory, Hypertension, Incidence, Mortality, Prevalence, Risk, Risk Factors, Stroke
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