50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study

doi:10.1016/S0140-6736(14)61774-8

. 2015 Jul 11;386(9989):154-62.

doi: 10.1016/S0140-6736(14)61774-8. Epub 2015 May 7.

50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study

Affiliations

¹ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Deutsches Zentrum fuer Herz-Kreislauf-Forschung, University Heart Center, Department of General and Interventional Cardiology, Hamburg, Germany. Electronic address: r.schnabel@uke.de.
² National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
³ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Division of Biostatistics and Health Services Research, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Boston, MA, USA.
⁴ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; Department of Mathematics and Statistics, Boston University, Boston, MA, USA.
⁵ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; Neurology Department, School of Medicine, Boston University, Boston, MA, USA.
⁶ Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Boston, MA, USA.
⁷ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Program in Medical Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA.
⁸ Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁹ Cardiology Section, School of Medicine, Boston University, Boston, MA, USA.
¹⁰ Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Program in Medical Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA.
¹¹ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA.
¹² National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Neurology Department, School of Medicine, Boston University, Boston, MA, USA; Preventive Medicine Section, School of Medicine, Boston University, Boston, MA, USA.
¹³ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Whitaker Cardiovascular Institute, School of Medicine, Boston University, Boston, MA, USA; Evans Memorial Medicine Department, School of Medicine, Boston University, Boston, MA, USA; Cardiology Section, School of Medicine, Boston University, Boston, MA, USA; Preventive Medicine Section, School of Medicine, Boston University, Boston, MA, USA.
¹⁴ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Whitaker Cardiovascular Institute, School of Medicine, Boston University, Boston, MA, USA; Evans Memorial Medicine Department, School of Medicine, Boston University, Boston, MA, USA; Cardiology Section, School of Medicine, Boston University, Boston, MA, USA; Preventive Medicine Section, School of Medicine, Boston University, Boston, MA, USA.
¹⁵ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Preventive Medicine Section, School of Medicine, Boston University, Boston, MA, USA; Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.

PMID: 25960110
PMCID: PMC4553037
DOI: 10.1016/S0140-6736(14)61774-8

50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study

Renate B Schnabel et al. Lancet. 2015.

. 2015 Jul 11;386(9989):154-62.

doi: 10.1016/S0140-6736(14)61774-8. Epub 2015 May 7.

Authors

Affiliations

¹ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Deutsches Zentrum fuer Herz-Kreislauf-Forschung, University Heart Center, Department of General and Interventional Cardiology, Hamburg, Germany. Electronic address: r.schnabel@uke.de.
² National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
³ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Division of Biostatistics and Health Services Research, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Boston, MA, USA.
⁴ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; Department of Mathematics and Statistics, Boston University, Boston, MA, USA.
⁵ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; Neurology Department, School of Medicine, Boston University, Boston, MA, USA.
⁶ Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Boston, MA, USA.
⁷ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Program in Medical Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA.
⁸ Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁹ Cardiology Section, School of Medicine, Boston University, Boston, MA, USA.
¹⁰ Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Program in Medical Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA.
¹¹ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA.
¹² National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Neurology Department, School of Medicine, Boston University, Boston, MA, USA; Preventive Medicine Section, School of Medicine, Boston University, Boston, MA, USA.
¹³ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Whitaker Cardiovascular Institute, School of Medicine, Boston University, Boston, MA, USA; Evans Memorial Medicine Department, School of Medicine, Boston University, Boston, MA, USA; Cardiology Section, School of Medicine, Boston University, Boston, MA, USA; Preventive Medicine Section, School of Medicine, Boston University, Boston, MA, USA.
¹⁴ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Whitaker Cardiovascular Institute, School of Medicine, Boston University, Boston, MA, USA; Evans Memorial Medicine Department, School of Medicine, Boston University, Boston, MA, USA; Cardiology Section, School of Medicine, Boston University, Boston, MA, USA; Preventive Medicine Section, School of Medicine, Boston University, Boston, MA, USA.
¹⁵ National Heart, Lung, and Blood Institute's Framingham Study, Framingham, MA, USA; Preventive Medicine Section, School of Medicine, Boston University, Boston, MA, USA; Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.

PMID: 25960110
PMCID: PMC4553037
DOI: 10.1016/S0140-6736(14)61774-8

Abstract

Background: Comprehensive long-term data on atrial fibrillation trends in men and women are scant. We aimed to provide such data through analysis of the Framingham cohort over 50 years.

Methods: We investigated trends in incidence, prevalence, and risk factors for atrial fibrillation and its association with stroke and mortality after onset in 9511 participants enrolled in the Framingham Heart Study between 1958 and 2007. We analysed trends within 10 year groups (1958-67, 1968-77, 1978-87, 1988-97, and 1998-2007), stratified by sex.

Findings: During 50 years of observation (202,417 person-years), 1544 cases of new-onset atrial fibrillation occurred (of whom 723 [47%] were women). Between 1958-67 and 1998-2007, age-adjusted prevalence of atrial fibrillation quadrupled from 20·4 to 96·2 cases per 1000 person-years in men and from 13·7 to 49·4 cases per 1000 person-years in women; age-adjusted incidence increased from 3·7 to 13·4 new cases per 1000 person-years in men and from 2·5 to 8·6 new cases per 1000 person-years in women (ptrend<0·0001 for all comparisons). For atrial fibrillation diagnosed by electrocardiograph (ECG) during routine Framingham examinations, age-adjusted prevalence per 1000 person-years increased (12·6 in 1958-67 to 25·7 in 1998-2007 in men, ptrend=0·0007; 8·1 to 11·8 in women, ptrend=0·009). However, age-adjusted incidence of atrial fibrillation by Framingham Heart Study ECGs did not change significantly with time. Although the prevalence of most risk factors changed over time, their associated hazards for atrial fibrillation changed little. Multivariable-adjusted proportional hazards models revealed a 74% (95% CI 50-86%) decrease in stroke (hazards ratio [HR] 3·77, 95% CI 1·98-7·20 in 1958-1967 compared with 1998-2007; ptrend=0·0001) and a 25% (95% CI -3-46%) decrease in mortality (HR 1·34, 95% CI 0·97-1·86 in 1958-1967 compared with 1998-2007; ptrend=0·003) in 20 years following atrial fibrillation onset.

Interpretation: Trends of increased incidence and prevalence of atrial fibrillation in the community were probably partly due to enhanced surveillance. Measures are needed to enhance early detection of atrial fibrillation, through increased awareness coupled with targeted screening programmes and risk factor-specific prevention.

Funding: NIH, NHLBI, NINDS, Deutsche Forschungsgemeinschaft.

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Figures

**Figure 1**
Age-adjusted Survival after the New Onset of Atrial Fibrillation by Sex and Time Period.

See this image and copyright information in PMC

Comment in

Taking the pulse of atrial fibrillation.
Potter BJ, Le Lorier J. Potter BJ, et al. Lancet. 2015 Jul 11;386(9989):113-5. doi: 10.1016/S0140-6736(14)61991-7. Epub 2015 May 7. Lancet. 2015. PMID: 25960109 No abstract available.

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References

1. Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114:119–25. - PubMed
1. Krijthe BP, Kunst A, Benjamin EJ, Lip GY, Franco OH, Hofman A, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J. 2013;34:2746–51. - PMC - PubMed
1. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129:837–47. - PMC - PubMed
1. Andersson T, Magnuson A, Bryngelsson IL, Frobert O, Henriksson KM, Edvardsson N, et al. All-cause mortality in 272,186 patients hospitalized with incident atrial fibrillation 1995-2008: a Swedish nationwide long-term case-control study. Eur Heart J. 2013;34:1061–7. - PMC - PubMed
1. Wattigney WA, Mensah GA, Croft JB. Increased atrial fibrillation mortality: United States, 1980-1998. Am J Epidemiol. 2002;155:819–26. - PubMed

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[1] Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114:119–25. - PubMed

[2] Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114:119–25. - PubMed

[3] Krijthe BP, Kunst A, Benjamin EJ, Lip GY, Franco OH, Hofman A, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J. 2013;34:2746–51. - PMC - PubMed

[4] Krijthe BP, Kunst A, Benjamin EJ, Lip GY, Franco OH, Hofman A, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J. 2013;34:2746–51. - PMC - PubMed

[5] Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129:837–47. - PMC - PubMed

[6] Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129:837–47. - PMC - PubMed

[7] Andersson T, Magnuson A, Bryngelsson IL, Frobert O, Henriksson KM, Edvardsson N, et al. All-cause mortality in 272,186 patients hospitalized with incident atrial fibrillation 1995-2008: a Swedish nationwide long-term case-control study. Eur Heart J. 2013;34:1061–7. - PMC - PubMed

[8] Andersson T, Magnuson A, Bryngelsson IL, Frobert O, Henriksson KM, Edvardsson N, et al. All-cause mortality in 272,186 patients hospitalized with incident atrial fibrillation 1995-2008: a Swedish nationwide long-term case-control study. Eur Heart J. 2013;34:1061–7. - PMC - PubMed

[9] Wattigney WA, Mensah GA, Croft JB. Increased atrial fibrillation mortality: United States, 1980-1998. Am J Epidemiol. 2002;155:819–26. - PubMed

[10] Wattigney WA, Mensah GA, Croft JB. Increased atrial fibrillation mortality: United States, 1980-1998. Am J Epidemiol. 2002;155:819–26. - PubMed

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50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study

Affiliations

50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study

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