Spatiotemporal patterns of the atrial fibrillation/flutter burden due to environmental, behavioral, and metabolic risk factors, 1990-2021: results from the GBD 2021.

BACKGROUND

Patients with atrial fibrillation/flutter (AF/AFL) face higher risks of death, heart failure, and thromboembolic events, with major attributable risk factors.

OBJECTIVE

This study examined epidemiological data and trends on six major risk factors contributing to the AF/AFL burden from the 2021 Global Burden of Disease (GBD) study.

METHODS

AF/AFL risk-attributable deaths, disability-adjusted life years (DALYs), and age-standardised mortality (ASMR) and DALY (ASDRs) rates from 1990 to 2021 were extracted from the GBD database. Future trends were predicted using the ARIMA model, and annual percentage changes assessed major risk factors and regional disease burden differences, with subgroup analyses by socio-demographic index (SDI) regions and countries. Statistical analysis was performed using R software version 4.3.1, and a two-sided p < 0.05 was considered statistically significant.

RESULTS

Environmental, behavioural, and metabolic risk factors significantly influenced the AF/AFL burden from 1990 to 2021, with ASMRs and ASDRs showing clear spatial and temporal patterns.

FORECASTED TRENDS: Deaths and DALYs attributable to these risk factors are projected to continue rising over the next 30 years, with body mass index (BMI) driving the largest increase in AF/AFL burden, while environmental and behavioural influences are expected to plateau.

SPATIAL VARIATION: Regional disparities remain, with high-SDI areas experiencing burden stabilisation through improved risk factor control, whereas low-SDI regions - particularly those undergoing rapid urbanisation with higher lead exposure and alcohol use - face increasing burdens, especially from metabolic risks.

CONCLUSION

AF/AFL burden will continue to rise, primarily driven by metabolic risks such as high BMI, with regional disparities highlighting the need for targeted preventive strategies.