Addressing the growing burden of atrial fibrillation: evidence, sustainability and accessibility more important than territory

Abstract

The systematic review by Lowres and colleagues 1 describes best current evidence on lifestyle interventions in atrial fibrillation (AF) patients. The findings are noteworthy, encouraging and tantalizing.The promise of lifestyle interventions is evident in the review. Although the review only included five trials of moderate quality, the findings are broadly positive. Lowres et al. 1 found the interventions, which focused predominantly on exercise, reduced heart rate at rest (9-15%) and during moderate exercise (6-9%), and improved exercise capacity and health-related quality of life in AF patients.The review also drew attention to important trends. The comparatively low volume and quality of research into the interventions is in inverse proportion to the current and future AF burden. In highincome countries, the prevalence of AF will double over the next 40 years. 2 As with heart failure (HF), the increasing burden of AF has its roots in rising life expectancy. 2 Risk of AF increases 25-fold from ages 55-85 years 3 and almost 1 in 5 people aged 85 or over have AF. 3 Rising obesity levels compound these patterns. A recent high-quality meta-analysis of 16 epidemiological studies identified that obesity increases risk of AF by 49% (RR: 1.49, 95% CI:1.36 to 1.64). 4

Dehydroepiandrosterone sulfate levels and risk of atrial fibrillation: The Rotterdam Study

“…Since atrial fibrillation is highly prevalent in the elderly, and is associated with serious morbidity and mortality, it is a major public health problem. 36 Effective prevention strategies may arise from studies on biomarkers that are associated with the risk of atrial fibrillation. Our results show that DHEAS can be regarded as an important indicator for the risk of atrial fibrillation.…”