Prevalence of Atrial Fibrillation Subtypes in Italy and Projections to 2060 for Italy and Europe

Abstract

BACKGROUND/OBJECTIVES: Atrial fibrillation (AF) subtypes may carry different cardiovascular risk profiles, but information on their frequency from population-based studies is lacking. We estimated prevalence of AF subtypes in a representative sample of the Italian older population, projecting figures for Italy and the European Union. DESIGN: Cross-sectional study. SETTING: Three primary care practices in northern, central, and southern Italy. PARTICIPANTS: All individuals aged 65 years or older, for a total sample of 6,016 subjects. Excluding 235 noneligible, participation was 78.3%, which left 4,528 participants. MEASUREMENTS: A double systematic and opportunistic screening procedure identified possible AF cases, followed by clinical and electrocardiogram confirmation. Patients were categorized with paroxysmal, persistent, or permanent AF. Prevalence was calculated by sex and 5-year age groups. Prevalence figures were applied to population projections for all 28 European Union states to estimate AF subtypes expected in future decades. RESULTS: In the 4,528 participants (mean age = 74.5 ± 6.8 years; 47.2% men), 331 AF cases were identified: 140 (42.3%) paroxysmal, 77 (23.3%) persistent, and 114 (34.4%) permanent. Prevalence was 3.1% (95% confidence interval (CI) = 2.6%-3.6%) for paroxysmal, 1.7% (95% CI = 1.4%-2.1%) for persistent, and 2.5% (95% CI = 2.1%-3.0%) for permanent AF. Italian older persons having AF in 2016 were estimated at approximately 449,000 for paroxysmal, approximately 240,000 for persistent, and approximately 391,000 for permanent AF, projected to increase in 2060 to approximately 785,000, approximately 358,000, and approximately 748,000, respectively. European Union older persons having AF in 2016 were estimated at approximately 3,185,000 for paroxysmal, approximately 1,722,000 for persistent, and approximately 2,710,000 for permanent AF, projected to increase in 2060 to approximately 5,989,000, approximately 2,833,000, and approximately 5,579,000, respectively. CONCLUSION: We provided first projections of AF subtypes for Italy and Europe. The worse cardiovascular risk profile of persistent and permanent forms indicates an increased burden in future decades.

Effect of Oral Anticoagulants in Atrial Fibrillation Patients with Polypharmacy: A Meta-analysis

“…Polypharmacy is common in the elderly, often accompanied by AF. 1 2 The meta-analysis by Harskamp et al 16 enrolling two post-hoc analyses of RCTs showed that the frequencies of bleeding events and mortality, but not SSE, were positively associated with the number of concomitant drugs. Our study yielded similar findings after including more high-quality retrospective studies and post-hoc analyses of RCTs.…”

“…Atrial fibrillation (AF) is a cardiac arrhythmia that is more common in the elderly, particularly those aged between 65 and 85 years, who make up nearly 70% of AF patients. 1 2 Elderly AF patients often have a heavy comorbidity burden and simultaneously use multiple drugs, a condition known as polypharmacy. However, there is no international consensus on the threshold and measurement methods of drug use.…”

Influence of atrial fibrillation subtypes on anticoagulant therapy in a high-risk older population: the FAI project

“…Our findings come from a population-based, multicentre study with a nationwide representative sample, which makes results transferable to the Italian older population. Data on frequency of AF subtypes were achieved through a combined screening procedure, which reduced the chance of missing AF cases, and on the direct clinical and ECG evaluation of all positive participants [ 29 ]. All the remaining clinical information was collected from the computerized practice records, and directly from the GPs and the patients.…”

Exercise and Atrial Fibrillation: The Dose Makes the Poison? A Narrative Review

“…Thus, the prevalence is 10% in people >65 years old and >15% among the >80-year-olds 1 . In the coming decades, the prevalence of AF in Europe is calculated to reach ~ 25 million patients 2 3 , likely further elevated by improved detection tools (i. e. smart watches). Atrial fibrillation is one of the leading causes of hospitalization 4 5 6 .…”