Global and regional burden of ischemic stroke associated with atrial fibrillation, 2009-2019

Prev Med. 2023 Aug:173:107584. doi: 10.1016/j.ypmed.2023.107584. Epub 2023 Jun 20.

Abstract

The extent of the preventable burden of ischaemic stroke associated with atrial fibrillation (AF) remains uncertain to date. To address this knowledge gap, we utilised the comparative risk assessment methodology to estimate the burden of ischaemic stroke associated with AF at both global and regional levels. The population attributable fraction for ischaemic stroke and AF was obtained from published literature, while data on the prevalence, incidence, deaths, and disability-adjusted life years (DALY) associated with ischaemic stroke were sourced from the Global Burden of Disease study database. Our analysis revealed that in 2019, globally, there were an estimated 0.7 (95% uncertainty interval [UI] of 0.55 to 0.83) million incident cases, 6.9 (5.81 to 8.12) million prevalence cases, 0.3 0.25 to 0.34) million deaths and 5.7 (4.91 to 6.57) million DALY resulting from ischaemic stroke associated with AF. The age-standardised death and DALY rates declined between 2009 and 2019 in all regions to varying degrees. Conversely, the age-standardised incidence and prevalence rates reduced only in high-income countries, Central Europe, Eastern Europe and Central Asia and Latin America and Caribbean regions. It is likely that our findings under-estimated the true burden of ischaemic stroke associated with AF due to limitations such as the use of a fixed population attributable fraction and poor quality of data. Nevertheless, we believe that our estimates provide valuable insights and highlight the urgent need for optimised management of AF through the implementation of efficacious interventions. Such efforts can help reduce the occurrence of preventable ischaemic strokes.

Keywords: Atrial fibrillation; Burden of disease; Global burden; Ischemic stroke; Regional burden; Time trends.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Atrial Fibrillation* / complications
  • Atrial Fibrillation* / epidemiology
  • Brain Ischemia* / epidemiology
  • Global Burden of Disease
  • Global Health
  • Humans
  • Incidence
  • Ischemic Stroke*
  • Prevalence
  • Quality-Adjusted Life Years
  • Risk Factors
  • Stroke* / epidemiology