Atrial fibrillation is becoming more common and can lead to heart failure

Atrial fibrillation (AF), a condition often characterised by an irregular heartbeat, is increasingly becoming a significant public health concern. Currently affecting more than 37 million people globally and rising at exponential rates annually with many not even aware that they have developed the condition, AF could soon become of the leading contributing factors to rising excess death rates. Recent studies by the Danish Center for Health Services Research at Aalborg University have provided a comprehensive analysis of the rising incidence of AF and its complications over the past two decades. These findings, published in the British Medical Journal (BMJ), underscore the growing prevalence and severe consequences of this condition.

Rising incidence of atrial fibrillation

The Danish study, covering the period from 2000 to 2022, reveals a stark increase in the number of individuals diagnosed with atrial fibrillation. The lifetime risk of developing AF has surged from 25% to 33%, meaning one in three individuals can expect to be diagnosed with this condition during their lifetime. Symptoms of AF typically include fatigue, palpitations, and shortness of breath, which can significantly impact quality of life.

These study findings align with other studies worldwide. In Europe, the BiomarCaRE Consortium reported similar lifetime risks, while studies in the US, China, Thailand and Taiwan reflected comparable trends. While the increasing detection of atrial fibrillation due to advancements in medical technology and better awareness contributes to these rising figures, other factors such as viral infections, and usage of certain vaccines and drugs have also been linked to the rising phenomena. Moreover, longer life expectancy and improved survival rates after heart conditions like myocardial infarction and heart failure increase the likelihood of developing atrial fibrillation as well!

According to postdoctoral researcher Dr Nicklas Vinter, MD, PhD, the increase in AF cases is not solely due to negative developments. As a population, we are living longer and have become better at treating various heart diseases that previously resulted in higher mortality rates. Consequently, we now have an ageing population with more susceptible hearts. Additionally, advancements in medical diagnostics have improved our ability to detect AF, contributing to the higher incidence rates.

“Ultimately, it is positive that people live longer and thus reach an age where they are at risk of getting other diseases,” says Dr Vinter.

“But we are dealing with a growing disease that is associated with serious complications, and it will pose a significant challenge to health services. Preventive efforts against atrial fibrillation are important to reduce the growing incidence.”

Heart failure: The most common complication

While the most well-known complication of atrial fibrillation is stroke, the Danish study highlights that heart failure is the most frequent and severe consequence. The study shows that 20% of individuals with AF will experience a stroke, and this risk has only decreased slightly over the last 20 years. More concerning is that 40% of individuals with AF develop heart failure, a figure much higher than previously assumed. The risk of heart failure following an AF diagnosis is twice as high as the risk of stroke.

Dr Vinter notes, “That the risk of heart failure after atrial fibrillation is so high is the most surprising finding. Heart failure after atrial fibrillation is associated with a poor prognosis, and every third person with atrial fibrillation dies of heart failure. Therefore, it is crucial that action is taken.”

The study’s findings call for a shift in focus for healthcare providers. While stroke prevention remains a priority, there is a pressing need to address heart failure prevention and treatment more effectively. The international guidelines for AF treatment should be revised to prioritise heart failure management alongside stroke prevention.

Addressing the growing challenge

The increasing incidence of atrial fibrillation and its associated complications presents a significant challenge to healthcare systems worldwide. In Denmark, more than 85% of patients with AF are prescribed oral anticoagulation, with high adherence rates. Despite this, stroke remains a substantial risk, highlighting the need for continued advancements in stroke prevention treatments. Emerging therapies, such as Factor XIa inhibitors and left atrial appendage closure, are currently being evaluated in clinical trials as potential first-line stroke prevention measures.

Furthermore, the study emphasises the importance of lifestyle modifications and adherence to prescribed medications for patients with AF. Classic advice regarding diet, smoking, alcohol consumption, and exercise remains crucial in managing the condition and preventing complications.

Dr Vinter stresses the need for increased attention to heart failure prevention among healthcare professionals. “The biggest problem arises if the prevention and treatment of heart failure after atrial fibrillation do not get greater attention. The preventive treatment of stroke should hopefully become even better in the future, but now prevention and treatment of heart failure need to be prioritised higher.”

Implications for public health

The findings from the Danish study provide critical insights into the long-term burden of atrial fibrillation and its complications. With the lifetime risk of AF now affecting one in three individuals, it is imperative to enhance public awareness and preventive strategies. Effective communication of the risks associated with AF can motivate lifestyle changes and improve adherence to medical recommendations.

Preventive strategies should include comprehensive risk assessments for AF and its complications, with a focus on primary and secondary prevention. The study’s lifetime risk estimates offer valuable information for public health planning and policy development, emphasizing the need for robust health interventions to mitigate the impact of AF and its complications.

The Danish study highlights the urgent need for a dual focus on stroke and heart failure prevention in the management of atrial fibrillation. As the incidence of AF continues to rise, proactive measures are essential to reduce the burden of this condition and improve outcomes for affected individuals.

Readers are strongly advised that in this current post-COVID-19 pandemic era, individuals should get checked for possible atrial fibrillation issues and also seek out the latest treatment protocols available as a preventive measure against possible heart failures. To book an appointment with a leading cardiologist or electrophysiologist, contact MyMeditravel.