Atrial Fibrillation: Epidemiology in the world and in Italy. Massimo Zoni Berisso Padre A. Micone Hospital Genoa, Italy
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1 Atrial Fibrillation: Epidemiology in the world and in Italy Massimo Zoni Berisso Padre A. Micone Hospital Genoa, Italy
2 Declaration of Interest No conflict
3 AF: relevant issue of public healthcare No lifethreatening arrhythmia Significantly affects the quality of life (functional, emotional, social) Direct or indirect cause of severe anatomical, coagulative, haemodynamic consequences (cardiac dilation, cardiac output, thromboembolism, bleeding) The most frequent arrhythmia in clinical practice
4 Prevalence (general population aged >15 yy) % Cowan Heart 2013;99:1166 Zoni Berisso Am J Cardiol 2013;11:705 Friberg J Intern Med 2013;274:461 Wilke Europace 2013;15:486 Naccarelli GV Am J Cardiol 2009;104:1534 Long MJ Int J Cardiol 2011;148:48 Shavadia J Cardiovasc J Afr 2013;24:6 Marcolino MS EUROPACE 2015
5 Prevalence asymptomatic AF Clinical setting Diagnosis age percentage ALFA (1999) Generalist Cardiologists visit + ecg % out-hospital clinics CARAF (1996) Ambulatori MMG visit + ecg Adult 21% Ambulatori cardiologi Pronto Socc, Osp Camm(1980) GPs visit + Holter > % Asymptomatic subjects Marek (2011) Asympomatic students ecg % Molaschi Hospitalised Ptsx NoCV ecg > 80 28% (1995) causes
6 Prevalence Colilla S Am J Cardiol 2013;112:1142
7 Incidence x 1000 pers/year WSchmidt M Int J Cardiol 2016;225:30 Ilke Europace 2013;15:486 Martinez Heart 2015;doi Colilla Am J Cardiol 2013;112:1142 Renoux Am Heart Assoc 2014;3:e Watanabe Am Heart J 2009;158:629
8 Incidence UK USA Martinez C Heart 2015;doi Colilla S Am J Cardiol 2013;112:1142
9 Distribution by age Tot Males Fem Males Tot Fem > 85 Zoni Berisso et al ISAF Study Am J Cardiol 2013;111:705
10 Distribution by sex Worldwide epidemiology of atrial fibrillation Chugh SS Circulation 2014;129:837
11 Distribution by race UK USA > 18 yrs Martinez C. Heart 2015;doi Dewland Circulation 2013;128:2470
12 Population characteristics Heart Disease Isch Hypert NICMP Valv Others (%) (%) (%) (%) (%) ISAF AFNET Euro Heart Survey ATRIA 35 5 TAIWAN ATRIA JAMA 2001;285:2370 ISAF Am J Cardiol 2013;111:705 AFNET Europace 2009;11:423 Euro Heart Survey Eur Heart J 2005;26:242 TAIWAN Am J Med 2007;120:e1-e7
13 Population characteristics Comorbidities HF Hypert COPD Ict/TIA Cognit Def Diab Ren Ins (%) (%) (%) (%) (%) (%) (%) ATRIA TAIWAN ISAF AFNET Euro Heart Sur ATRIA JAMA 2001;285:2370 TAIWAN Am J Med 2007;120:e1-e7 ISAF Am J Cardiol 2013;111:70 AFNET Europace 2009;11:423 Euro Heart Survey Eur Heart J 2005;26:2422
14 Population characteristics Real-life Global Survey Evaluating Patients with Atrial Fibrillation pz 26 Nazioni Chiang Circ Arrhythm Electrophysiol 2012;5:632
15 Types of AF Chiang CE Circ Arrh Electrophysiol 2012;5:632 ISAF Am J Cardiol 2013;111:705 AFNET Europace 2009;11:42 Euro Heart Survey Eur Heart J 2005;26:2422 ATA-AF Europace 2011 (Abstract)
16 Hospitalisations USA ATRIUM Clin Res Cardiol 2011;100:897 ISAF Giorn Ital Cardiol 2012: (Suppl 1) Ruskin Heart Rhythm 2004;1(Issue 2, Suppl):31
17 Ischemic/hemorragic stroke Pz Medicare con FA + età > 65 aa Shroff JAMA Intern Med 2013;173:159 Friberg Circulation 2012;125:2298
18 Prognosis: AF and risk of ischemic stroke Stroke (%) Real-life Global Survey Circ Arrhythm Electrophysiol 2012;5:632 EORP-AF Eur Heart J 2014;36:3365
19 Prognosis: mortality Andersson Eur Heart J 2013;3:1061
20 Prognosis: mortality Global Burden of Atriial Fibrillation Global Heart 2014;9:113
21 Prognosis: type of AF and mortality FA perm HR 1.6, CI 1, Keating RJ Olmsted County Am J Cardiol 2005;96:1420 Friberg et al Eur Heart J 2007;28:2346
22 Prognosis Denmark ( subjects) from 1983 to 2012 Heart failure 50% Mortality 40% Ischemic stroke 20% Hemorragic stroke 14% Schmidt M Int J Cardiol 2016;225:30
23 Antiarrhythmic treatment strategy (Rhythm control) Territorio Osp Cardiol Osp + Territ ATRIUM Clin Res Cardiol 2011;100:897 ISAF Am J Cardiol 2013;111:705 ORBIT Am Heart J 2013;165:622 AFFECTS Am J Cardiol 2010;105:1122 LaPointe Am J Cardiol 2008;101:1134 Quebec Arch Intern Med 2012;172:997
24 Antithrombotic therapy Italy UK Japan Anticoagulants 63% 54% 58% Reasons of AC nonuse Contraindication 6% 9% Refiusal 5% 2.2% 20% Pt/care giver unreliability 7% 4% Unknown 20% 30% 22% Filippi A Sudio ISAF Eur J Intern Med 2013;24:3114 Inoue H Circ J 2004;68:417 Cowan J Heart 2013;99:1166
25 Conclusions 1) Prevalence of AF is growing and, at least in Europe, is twice than that reported in the past decade 2) The differences in prevalence and incidence among nations are mainly related to race, population mean age and level of development of the national healthcare systems 3) Italian epidemiologic data are similar to those observed in the developed countries
26 Transcatheter ablation % 5% 3% 3% AFNET ATRIUM ISAF EuroHeart ATRIUM Clin Res Cardiol 2011;100:897 Studio ISAF Am J Cardiol 2013;111:705 Euro Heart Survey Eur Heart J 2005;26:2422 AFNET Europace 2009;11:423
27 Prognosis: type of AF and the ischemic stroke risk Frieberg L Eur Heart J 2010;31:968
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