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National Implications for Rhythm Management and Stroke Prevention: the AnTicoagulation and Risk Factors In Atrial Fibrillation (ATRIA) Study

Alan S. Go, MD; Elaine M. Hylek, MD,MPH; Kathleen A. Phillips, BA; YuChiao Chang, PhD; Lori E. Henault, MPH; Joe V. Selby, MD,MPH; Daniel E. Singer, MD

JAMA. 2001;285:2370-2375.

Context  Atrial fibrillation is the most common arrhythmia in elderly persons and a potent risk factor for stroke. However, recent prevalence and projected future numbers of persons with atrial fibrillation are not well described.

Objective  To estimate prevalence of atrial fibrillation and US national projections of the numbers of persons with atrial fibrillation through the year 2050.

Design, Setting, and Patients  Cross-sectional study of adults aged 20 years or older who were enrolled in a large health maintenance organization in California and who had atrial fibrillation diagnosed between July 1, 1996, and December 31, 1997.

Main Outcome Measures  Prevalence of atrial fibrillation in the study population of 1.89 million; projected number of persons in the United States with atrial fibrillation between 1995-2050.

Results  A total of 17 974 adults with diagnosed atrial fibrillation were identified during the study period; 45% were aged 75 years or older. The prevalence of atrial fibrillation was 0.95% (95% confidence interval, 0.94%-0.96%). Atrial fibrillation was more common in men than in women (1.1% vs 0.8%; P<.001). Prevalence increased from 0.1% among adults younger than 55 years to 9.0% in persons aged 80 years or older. Among persons aged 50 years or older, prevalence of atrial fibrillation was higher in whites than in blacks (2.2% vs 1.5%; P<.001). We estimate approximately 2.3 million US adults currently have atrial fibrillation. We project that this will increase to more than 5.6 million (lower bound, 5.0; upper bound, 6.3) by the year 2050, with more than 50% of affected individuals aged 80 years or older.

Conclusions  Our study confirms that atrial fibrillation is common among older adults and provides a contemporary basis for estimates of prevalence in the United States. The number of patients with atrial fibrillation is likely to increase 2.5-fold during the next 50 years, reflecting the growing proportion of elderly individuals. Coordinated efforts are needed to face the increasing challenge of optimal stroke prevention and rhythm management in patients with atrial fibrillation.

Author Affiliations: Division of Research, Kaiser Permanente of Northern California, Oakland (Drs Go and Selby and Ms Phillips); Departments of Epidemiology, Biostatistics, and Medicine, University of California at San Francisco (Dr Go); Clinical Epidemiology Unit, General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Drs Hylek, Chang, and Singer, and Ms Henault).

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