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

被引：47

作者：

Joseph, Philip G. ^{[1
]}

Healey, Jeffrey S. ^{[1
]}

Raina, Parminder ^{[2
]}

Connolly, Stuart J. ^{[1
]}

Ibrahim, Quazi ^{[1
]}

Gupta, Rajeev ^{[3
]}

Avezum, Alvaro ^{[4
]}

Dans, Antonio L. ^{[5
]}

Lopez-Jaramillo, Patricio ^{[6
]}

Yeates, Karen ^{[7
]}

Teo, Koon ^{[1
]}

Douma, Reuben ^{[1
]}

Bahonar, Ahmad ^{[8
]}

Chifamba, Jephat ^{[9
]}

Lanas, Fernando ^{[10
]}

Dagenais, Gilles R. ^{[11
]}

Lear, Scott A. ^{[12
]}

Kumar, Rajesh ^{[13
]}

Kengne, Andre P. ^{[14
]}

Keskinler, Mirac ^{[15
]}

Mohan, Viswanathan ^{[16
]}

Mony, Prem ^{[17
]}

Alhabib, Khalid F. ^{[18
]}

Huisman, Hugo ^{[19
,20
]}

Iype, Thomas ^{[21
]}

Zatonska, Katarzyna ^{[22
]}

Ismail, Rosnah ^{[23
]}

Kazmi, Khawar ^{[24
]}

Rosengren, Annika ^{[25
,26
]}

Rahman, Omar ^{[27
]}

Yusufali, Afzalhussein ^{[28
]}

Wei, Li ^{[29
,30
]}

Orlandini, Andres ^{[31
]}

Islam, Shofiqul ^{[1
]}

Rangarajan, Sumathy ^{[1
]}

Yusuf, Salim ^{[1
]}

机构：

[1] McMaster Univ, Populat Hlth Res Inst, 237 Barton St East, Hamilton, ON L8L 2X2, Canada

[2] McMaster Univ, Canadian Longitudinal Study Aging, Hamilton, ON, Canada

[3] Eternal Heart Care Ctr & Res Inst, Jaipur, Rajasthan, India

[4] Hosp Alemao Oswaldo Cruz & UNISA, Sao Paulo, Brazil

[5] Philippines Gen Hosp, Manila, Philippines

[6] Univ Santander UDES, Masira Res Inst, Bucaramanga, Colombia

[7] Queens Univ, Kingston, ON, Canada

[8] Isfahan Univ Med Sci, Isfahan Cardiovasc Res Ctr, Cardiovasc Res Inst, Esfahan, Iran

[9] Univ Zimbabwe, Dept Physiol, Harare, Zimbabwe

[10] Univ La Frontera, Temuco, Chile

[11] Univ Laval, Quebec City, PQ, Canada

[12] Simon Fraser Univ, Burnaby, BC, Canada

[13] Post Grad Inst Med Educ & Res PGIMER, Sch Publ Hlth, Chandigarh, India

[14] South African Med Res Council, Pietermaritzburg, South Africa

[15] Istanbul Goztepe Training & Res Hosp, Istanbul, Turkey

[16] Madras Diabet Res Fdn, Chennai, Tamil Nadu, India

[17] St Johns Med Coll & Res Inst, Bengaluru, India

[18] King Saud Univ, Coll Med, King Fahad Cardiac Ctr, Dept Cardiac Sci, Riyadh, Saudi Arabia

[19] North West Univ, Hypertens Africa Res Team HART, Potchefstroom, South Africa

[20] North West Univ, South African Med Res Council, Unit Hypertens & Cardiovasc Dis, Potchefstroom, South Africa

[21] Govt Med Coll, Kozhikode, Kerala, India

[22] Med Univ Wroclaw, Dept Social Med, Wroclaw, Poland

[23] Univ Kebangsaan, Bangi, Selangor, Malaysia

[24] Aga Khan Univ, Karachi, Pakistan

[25] Univ Gothenburg, Sahlgrenska Acad, Dept Mol & Clin Med, Gothenburg, Sweden

[26] Sahlgrens Univ Hosp, Gothenburg, Sweden

[27] Independent Univ, Dhaka, Bangladesh

[28] Hatta Hosp, Dubai Hlth Author, Dubai, U Arab Emirates

[29] Fuwai Hosp, Peking Union Med Coll, Natl Ctr Cardiovasc Dis, Beijing, Peoples R China

[30] Chinese Acad Med Sci, Beijing, Peoples R China

[31] Estudios Clin Latinoamer ECLA, Santa Fe, Argentina

来源：

CARDIOVASCULAR RESEARCH | 2021年 / 117卷 / 06期

关键词：

Atrial fibrillation; Epidemiology; CLSA; ATHEROSCLEROSIS RISK; AIR-POLLUTION; EPIDEMIOLOGY; AF; MORTALITY; REGISTRY; EVENTS; STROKE; MODEL;

D O I：

10.1093/cvr/cvaa241

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 < 0.001). Compared with low-income countries (LICs), AF prevalence was 7-fold higher in middle-income countries (MICs) and 11-fold higher in high-income countries (HICs) (P < 0.001). Differences in AF prevalence remained significant after adjusting for traditional AF risk factors. In LICs/MICs, 24% of participants with AF and a CHADS2 score >= 1 received antithrombotic therapy, compared with 85% in HICs. AF was associated with an increased risk of stroke [hazard ratio (HR) 2.29; 95% confidence interval (CI) 1.49-3.52] and death (HR 2.97; 95% CI 2.25-3.93); with similar rates in different countries grouped by income level. Conclusions Large variations in AF prevalence occur in different regions and countries grouped by income level, but this is only partially explained by traditional AF risk factors. Antithrombotic therapy is infrequently used in poorer countries despite the high risk of stroke associated with AF. [GRAPHICS] .

引用

页码：1523 / 1531

页数：9

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