Global drivers of heart failure attributable to atrial fibrillation/flutter: insights from Joinpoint regression, age-period-cohort analysis, and future projections from the GBD 2021 Study.

backgroundHeart failure attributable to atrial fibrillation/flutter (HF-AF/AFL) represents a growing global public health challenge. However, comprehensive analyses of its long-term trends, the independent effects of age, period, and cohort, and future projections remain scarce. This study aimed to address these gaps by characterizing transitions in HF-AF/AFL burden from 1990 to 2021.

methodsBased on the Global Burden of Disease Study (GBD) 2021, we estimated the global prevalence and years lived with disability (YLDs) for HF-AF/AFL. Joinpoint regression was used to analyze temporal trends from 1990 to 2021. An age-period-cohort model assessed independent effects of age, period, and birth cohort, and a Bayesian age-period-cohort (BAPC) approach projected disease burden to 2050. All estimates were stratified by age, sex, and sociodemographic index (SDI).

resultsThe global burden of HF-AF/AFL increased significantly from 1990 to 2021, demonstrating a distinct socioeconomic gradient, with the highest burden observed in high-SDI regions. Although the absolute burden remained greater among females, the increase was more pronounced in males. Joinpoint regression identified a recent inflection point, marked by modest global declines in age-standardized prevalence (ASPR) and years lived with disability (ASYR) rates from 2018 to 2021; this downturn was particularly evident among females and in high-SDI regions. Age-period-cohort analysis confirmed an exponential increase in risk with age, a persistent rise in risk across successive periods, and elevated susceptibility in more recent birth cohorts. Projections indicate a continued rise in burden, with the number of prevalent cases forecast to reach approximately 1.44 million globally by 2050, corresponding to an ASPR of 15.04 per 100,000, and YLDs projected to rise to around 0.13 million, with an ASYR of 1.35 per 100,000. This upward trajectory was consistent across SDI strata, although future burdens exhibited regional heterogeneity.

conclusionsThe global burden of HF-AF/AFL is substantial and increasing. Our analysis projects a continued rise in this burden over the coming decades and identifies distinct risk patterns driven by age, period, and birth cohort. These findings underscore the necessity for targeted public health strategies to address this growing challenge.