Prevalence and risk of atrial fibrillation in China: A national cross-sectional epidemiological study

Shaobo Shi; Yanhong Tang; Qingyan Zhao; Hong Yan; Bin Yu; Qiangsun Zheng; Yigang Li; Liangrong Zheng; Yiqiang Yuan; Jingquan Zhong; Jian Xu; Yanqing Wu; Jing Xu; Lin Chen; Shufeng Li; Jian Jiang; Jingfeng Wang; Jie Fan; Minglong Chen; Baopeng Tang; Wei Li; Qiang Wu; Bei Shi; Shenghua Zhou; Xingsheng Zhao; Yuehui Yin; Zheng Zhang; Guoqiang Zhong; Xuebin Han; Fan Liu; Ming Wu; Lianjun Gao; Bo Yang; He Huang; Congxin Huang; China Atrial Fibrillation Center Project Team)

doi:10.1016/j.lanwpc.2022.100439

Prevalence and risk of atrial fibrillation in China: A national cross-sectional epidemiological study

Lancet Reg Health West Pac. 2022 Apr 11:23:100439. doi: 10.1016/j.lanwpc.2022.100439. eCollection 2022 Jun.

Authors

Shaobo Shi^{1

2

3}, Yanhong Tang^{1

2

3}, Qingyan Zhao^{1

2

3}, Hong Yan⁴, Bin Yu⁴, Qiangsun Zheng⁵, Yigang Li⁶, Liangrong Zheng⁷, Yiqiang Yuan⁸, Jingquan Zhong⁹, Jian Xu¹⁰, Yanqing Wu¹¹, Jing Xu¹², Lin Chen¹³, Shufeng Li¹⁴, Jian Jiang¹⁵, Jingfeng Wang¹⁶, Jie Fan¹⁷, Minglong Chen¹⁸, Baopeng Tang¹⁹, Wei Li²⁰, Qiang Wu²¹, Bei Shi²², Shenghua Zhou²³, Xingsheng Zhao²⁴, Yuehui Yin²⁵, Zheng Zhang²⁶, Guoqiang Zhong²⁷, Xuebin Han²⁸, Fan Liu²⁹, Ming Wu³⁰, Lianjun Gao³¹, Bo Yang^{1

2

3}, He Huang^{1

2

3}, Congxin Huang^{1

2

3}; China Atrial Fibrillation Center Project Team)

Affiliations

¹ Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China.
² Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China.
³ Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China.
⁴ School of Public Health,Wuhan University, Wuhan 430071, China.
⁵ The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China.
⁶ Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
⁷ The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
⁸ Henan Provincial Chest Hospital, Zhengzhou 450008, China.
⁹ Qilu Hospital of Shandong University, Jinan 250063, China.
¹⁰ Anhui Provincial Hospital, Hefei 230001, China.
¹¹ The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China.
¹² Tianjin Chest Hospital, Tianjin 300222, China.
¹³ Fujian Provincial Hospital, Fuzhou 350013, China.
¹⁴ The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China.
¹⁵ West China Hospital of Sichuan University, Chengdu 610044, China.
¹⁶ Sun Yat-sen Memorial Hospital, Guangzhou 510120, China.
¹⁷ The First People's Hospital of Yunnan Province, Kunming 650034, China.
¹⁸ Jiangsu Province Hospital, Nanjin 210029, China.
¹⁹ The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China.
²⁰ The Affiliated Hospital of Guizhou Medical University, Guizhou 550004, China.
²¹ Guizhou Provincial People's Hospital, Guizhou 550002, China.
²² Affiliated Hospital of Zunyi Medical University, Zunyi 563099, China.
²³ The Second Xiangya Hospital of Central South University, Changsha 430062, China.
²⁴ Inner Mongolia Autonomous Region People's Hospital, Huhehot 010020, China.
²⁵ The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China.
²⁶ The First Hospital of Lanzhou University, Lanzhou 730013, China.
²⁷ The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.
²⁸ Shanxi Cardiovascular Hospital, Taiyuan 030024, China.
²⁹ The Second Hospital of Hebei Medical University, Shijiazhuang 050004, China.
³⁰ Hainan General Hospital, Haikou 570311, China.
³¹ The First Affiliated Hospital of Dalian Medical University, Dalian 116051, China.

Abstract

Background: Atrial fibrillation (AF) is the most common persistent cardiac arrhythmia. This study aimed to estimate its prevalence and explore associated factors in adults aged 18 years or older in China.

Methods: Study data were derived from a national sample from July 2020 to September 2021. Participants were recruited using a multistage stratified sampling method from twenty-two provinces, autonomous regions, and municipalities in China. AF was determined based on a history of diagnosed AF or electrocardiogram results.

Findings: A total of 114,039 respondents were included in the final analysis with a mean age of 55 years (standard deviation 17), 52·1% of whom were women. The crude prevalence of AF was 2·3% (95% confidence interval [CI] 1·7-2·8) and increased with age. The age-standardized AF prevalence was 1·6% (95% CI 1·6-1·7%) overall, and 1·7% (1·6-1·8%), 1·4% (1·3-1·5%), 1·6% (95% CI 1·5-1·7%), and 1·7% (1·6-1·9%) in men, women, urban areas, and rural areas, respectively. The prevalence was higher in the central regions (2·5%, 2·3-2·7%) than in the western regions (1·5%, 1·0-2·0%) and eastern regions (1·1%, 1·0-1·2%) in the overall population, either in the gender or residency subgroups. The associated factors for AF included age (per 10 years; odds ratio 1·41 [95% CI 1·38-1·46]; p < 0·001), men (1·34 [1·24-1·45]; p < 0·001), hypertension (1·22 [1·12-1·33]; p < 0·001), coronary heart disease (1·44 [1·28-1·62]; p < 0·001), chronic heart failure (3·70 [3·22-4·26]; p < 0·001), valvular heart disease (2·13 [1·72-2·63]; p < 0·001), and transient ischaemic attack/stroke (1·22 [1·04-1·43]; p = 0·013).

Interpretation: The prevalence of AF was 1.6% in the Chinese adult population and increased with age, with significant geographic variation. Older age, male sex, and cardiovascular disease were potent factors associated with AF. It is crucial to increase the awareness of AF and disseminate standardized treatment in clinical settings to reduce the disease burden.

Funding: This research was supported the Nature Science Foundation of Hubei province (No: 2017CFB204).

Keywords: AF, atrial fibrillation; Adult; Atrial fibrillation; BMI, body mass index; CHD, coronary heart disease; CHF, chronic heart failure; CI, confidence interval; China; DM, diabetes mellitus; ECG, electrocardiogram; Factor; HTN, hypertension; OR, odds ratio; Prevalence; SD, standard deviation; TIA, transient ischaemic attack.