Objective  To analyze the disease burden and trend prediction of atrial fibrillation and atrial flutter (AF/AFL) in China from 1990 to 2021, and to provide reference for disease prevention and treatment.

Methods  Based on the 2021 Global Burden of Disease Database, Joinpoint regression model was used to analyze the temporal trend of AF/AFL disease burden, age-period-cohort model was used to analyze the age, period, and birth queue effects of AF/AFL, and autoregressive integrated moving average (ARIMA) model was used to predict the trend of AF/AFL disease burden from 2022 to 2031.

Results  In 2021, the number of new cases of AF/ AFL in China was 916,100, with a total of 10.7757 million patients and a disability-adjusted life years (DALY) of 1.6531 million person years. The death toll was 64,700, an increase of 198.89%, 237.24%, 225.03%, and 294.51% compared to 1990. Joinpoint regression analysis showed that the age-standardized incidence rate (ASIR)[AAPC=0.155%, 95%CI (0.051%, 0.260%)] and age-standardized prevalence rate (ASPR) [AAPC=0.433%, 95%CI (0.324%, 0.543%)] of AF/AFL from 1990 to 2021 showed an upward trend, and the age-standardized mortality rate [AAPC=-0.454%, 95%CI (-0.783%, -0.124%)] of AF/AFL showed a downward trend. The results of the age-period-cohort model showed that the incidence risk, disease risk, DALY risk, and mortality risk of AF/AFL increase with age, while the incidence and disease risks increase with time, and the mortality risk decreases over time. The cohort effect shows that people born in recent years have an increased risk of developing the disease, the risk of illness, and the risk of DALY. The ARIMA model predicted that the ASIR and ASPR of AF/ AFL in China will increase in the next 10 years.

Conclusion  From 1990 to 2021, the ASIR and ASPR of AF/AFL in China shows an increasing trend. The risk of incidence, morbidity, and DALY increases with age, and the incidence tends to be younger. The ASIR and ASPR of AF/AFL are likely to be on the rise over the next 10  years.

1.Zimetbaum P. Atrial fibrillation[J]. Ann Intern Med, 2017, 166(5): ITC33-ITC48. DOI: 10.7326/aitc201703070.

2.赖文文, 赵文安, 张志龙,等. 基于血清miRNA水平的非瓣膜性房颤患者消融术后复发风险预测列线图模型的构建与评价[J]. 解放军医学杂志, 2023, 48(6): 715-722. [Lai WW, Zhao WA, Zhang ZL, et al. Establishment of a recurrence risk prediction model for patients with nonvalvular atrial fibrillation after ablation based on serum miRNA levels[J]. Medical Journal of Chinese People's Liberation Army, 2023, 48(6): 715-722.] DOI: 10.11855/j.issn.0577-7402.2023.06.0715.

3.Chiang CE, Wang KL, Lin SJ. Asian strategy for stroke prevention in atrial fibrillation[J]. Europace, 2015, 17 Suppl 2: ii31-39. DOI: 10.1093/europace/euv231.

4.Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge[J]. Int J Stroke, 2021, 16(2): 217-221. DOI: 10.1177/1747493019897870.

5.Li Q, Li YL, Guo YS, et al. Global trends of schistosomiasis burden from 1990 to 2021 across 204 countries and territories: findings from GBD 2021 study[J]. Acta Trop, 2025, 261: 107504.DOI: 10.1016/j.actatropica.2024.107504.

6.覃丽虹, 陈静, 向涯碟,等. 1990—2021年我国慢性肾脏病疾病负担及其危险因素分析[J]. 医学新知, 2024, 34(9): 957-969. [Qin LH, Chen J, Xiang YD, et al. An analysis of disease burden and risk factors of chronic kidney disease in China from 1990 to 2021[J]. Yixue Xinzhi Zazhi, 2024, 34(9): 957-969.] DOI: 10.12173/j.issn.1004-5511.202408076.

7.周利慧, 彭琴, 王媛,等. 中国居民1993—2017年房颤发病及死亡趋势年龄-时期-队列模型分析[J]. 中国公共卫生, 2021, 37(11): 1672-1676. [Zhou LH, Peng Q, Wang  Y, et al. Incidence and mortality of atrial fibrillation in China, 1993-2017: an age-period-cohort analysis[J]. Chinese Journal of Public Health, 2021, 37(11): 1672-1676.] DOI: 10.11847/zgggws1131433.

8.GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017[J]. Lancet, 2018, 392(10159): 1789-1858. DOI: 10.1016/s0140-6736(18)32279-7.

9.黄子睿, 程雁, 陈果,等. 1990—2019年中国出生窒息/创伤所致新生儿脑病疾病负担分析[J]. 医学新知, 2024, 34(8): 843-851. [Huang ZR, Cheng Y, Chen G, et al. Analysis of the disease burden of neonatal encephalopathy due to birth asphyxia and trauma in China from 1990 to 2019[J]. Yixue Xinzhi Zazhi, 2024, 34(8): 843-851.] DOI: 10.12173/j.issn.1004-5511.202403040.

10.师维, 崔旋旋, 周伍明,等. 1990—2019年中国心肌炎疾病负担水平及其变化分析[J]. 医学新知, 2023, 33(5): 325-333. [Shi W, Cui XX, Zhou WM, et al. Analysis of the change in disease burden of myocarditis in China from 1990 to 2019[J]. Yixue Xinzhi Zazhi, 2023, 33(5): 325-333.] DOI: 10.12173/j.issn.1004-5511.202211067.

11.王瑾瑶, 张年萍, 白志强,等. 1993—2017年中国宫颈癌发病率和死亡率长期趋势的年龄-时期-队列模型分析[J]. 中国全科医学, 2022, 25(13): 1564-1568. [Wang JY, Zhang  NP, Bai ZQ, et al. Age-period-cohort analysis of secular trends of cervical cancer incidence and mortality in China, 1993—2017[J]. Chinese General Practice, 2022, 25(13): 1564-1568.] DOI: 10.12114/j.issn.1007-9572.2022.0074.

12.蒋露, 张志东, 吴建军,等. 1990—2021年我国精神障碍疾病负担分析与预测[J]. 医学新知, 2025, 35(1): 14-21. [Jiang L, Zhang ZD, Wu JJ, et al. Prediction and analysis of disease burden of mental disorders in China from 1990 to 2021[J]. Yixue Xinzhi Zazhi, 2025, 35(1): 14-21.] DOI: 10.12173/j.issn.1004-5511.202408089.

13.张莲, 殷春悦, 胡善联. 我国心房纤颤的疾病负担[J]. 中国卫生经济, 2013, 32(12): 5-7. [Zhang L, Yin CY, Hu SL. The illness burden brought by atrial fibrillation in China[J]. Chinese Health Economics, 2013, 32(12): 5-7.] DOI: 10.7664/CHE20131201.

14.刘映虹, 李南杰, 苏徽晖,等. 心房颤动患者维生素K水平与缺血性脑卒中的相关性研究[J]. 数理医药学杂志, 2022, 35(7): 1004-1006. [Liu YH, Li NJ, Su HH, et al. Correlation between vitamin K level and ischemic stroke in patients with atrial fibrillation[J]. Journal of Mathematical Medicine, 2022, 35(7): 1004-1006.] DOI: 10.3969/j.issn.1004-4337.2022.07.018.

15.Tang J, Zhang Q, Peng S, et al. Differences in global, regional, and national time trends in disability-adjusted life years for atrial fibrillation and flutter, 1990-2019: an age-period-cohort analysis from the 2019 global burden of disease study[J]. Front Cardiovasc Med, 2024, 11: 1401722. DOI: 10.3389/fcvm.2024.1401722.

16.杨蕾, 邬娜, 杨岚清,等. 外周血piR-hsa-2700592在房颤患者预后中的预测研究[J]. 陆军军医大学学报, 2025, 47(6): 551-560. [Yang L, Wu N, Yang LQ, et al. Predictive value of peripheral blood piR-hsa-2700592 for prognosis of atrial fibrillation patients[J]. Journal of Army Medical University, 2025, 47(6): 551-560.] DOI: 10.16016/j.2097-0927.202409107.

17.董志强, 刘洁云, 秦雷. 低密度脂蛋白联合左心房内径与非瓣膜性心房颤动患者心房血栓形成的相关性[J]. 西部医学, 2025, 37(3): 387-392. [Dong ZQ, Liu JY, Qin L. Value of left atrial internal diameter combined with low-density lipoprotein in predicting atrial thrombosis in non-valvular atrial fibrillation[J]. Medical Journal of West China, 2025, 37(3): 387-392.] DOI: 10.3969/j.issn.1672-3511.2025.03.014.

18.Dai H, Zhang Q, Much AA, et al. Global, regional, and national prevalence, incidence, mortality, and risk factors for atrial fibrillation, 1990-2017: results from the global burden of disease study 2017[J]. Eur Heart J Qual Care Clin Outcomes, 2021, 7(6): 574-582. DOI: 10.1093/ehjqcco/qcaa061.

19.王玲, 普雯. 房颤患者参与健康照护的意愿、现状及影响因素[J]. 心血管康复医学杂志, 2024, 33(5): 555-559. [Wang  L, Pu W. Willingness,current situation and influencing factors of patients with atrial fibrillation participating in health care[J]. Chinese Journal of Cardiovascular Rehabilitation Medicine, 2024, 33(5): 555-559.] DOI: 10.3969/j.issn.1008-0074.2024.05.09.

20.Ohlrogge AH, Brederecke J, Schnabel RB. Global burden of atrial fibrillation and flutter by national income: results from the global burden of disease 2019 database[J]. J Am Heart Assoc, 2023, 12(17): e030438. DOI: 10.1161/jaha.123.030438.

21.Kong X, Wang M, Jiang Y. Global burden of atrial fibrillation attributable to high body mass index from 1990 to 2021: findings from the global burden of disease study 2021[J]. BMC Cardiovasc Disord, 2024, 24(1): 542. DOI: 10.1186/s12872-024-04202-5.

22.Jiang C, Lan DH, Du X, et al. Prevalence of modifiable risk factors and relation to stroke and death in patients with atrial fibrillation: a report from the China atrial fibrillation registry study[J]. J Cardiovasc Electrophysiol, 2019, 30(12): 2759-2766. DOI: 10.1111/jce.14231.

23.Cheng S, He J, Han Y, et al. Global burden of atrial fibrillation/atrial flutter and its attributable risk factors from 1990 to 2021[J]. Europace, 2024, 26(7): euae195. DOI: 10.1093/europace/euae195.

24.Dong XJ, Wang BB, Hou FF, et al. Global burden of atrial fibrillation/atrial flutter and its attributable risk factors from 1990 to 2019[J]. Europace, 2023, 25(3): 793-803. DOI: 10.1093/europace/euac237.

25.Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J]. Circulation, 2024, 149(1): e1-e156. DOI: 10.1161/cir.0000000000001193.

26.January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the heart rhythm society[J]. J Am Coll Cardiol, 2019, 74(1): 104-132. DOI: 10.1016/j.jacc.2019.01.011.

27.曹鹏. 心房颤动与miRNA[J]. 新医学, 2023, 54(1): 55-58. [Cao  P. Atrial fibrillation and miRNA[J]. New Medicine, 2023, 54(1): 55-58.] DOI: 10.3969/j.issn.0253-9802.2023.01.012.

28.Li X, Liu Z, Jiang X, et al. Global, regional, and national burdens of atrial fibrillation/flutter from 1990 to 2019: an age-period-cohort analysis using the global burden of disease 2019 study[J]. J Glob Health, 2023, 13: 04154. DOI: 10.7189/jogh.13.04154.

29.Yang XM, Rao ZZ, Gu HQ, et al. Atrial fibrillation known before or detected after stroke share similar risk of ischemic stroke recurrence and death[J]. Stroke, 2019, 50(5): 1124-1129. DOI: 10.1161/strokeaha.118.024176.

30.Gawałko M, Dobrev D. Oral anticoagulation and therapy of atrial flutter: discontinuation of anticoagulation revisited[J]. Int J Cardiol, 2021, 333: 117-118. DOI: 10.1016/j.ijcard.2021.03.022.

31.张永红, 李志强, 程俊华. Sglt2抑制剂降低2型糖尿病合并心房颤动患者射频消融术后复发的疗效评估[J]. 中国循证心血管医学杂志, 2024, 16(12): 1502-1505, 1511. [Zhang  YH, Li ZQ, Cheng JH. Evaluation of the efficacy of SGLT2 inhibitors in reducing recurrence after radiofrequency ablation in patients with type 2 diabetes mellitus combined with atrial fibrillation[J]. Chinese Journal of Evidence-Bases Cardiovascular Medicine, 2024, 16(12): 1502-1505, 1511.] DOI: 10.3969/j.issn.1674-4055.2024.12.20.

32.谢敏, 崔凯军. 冷冻球囊消融在心房颤动一线治疗中的应用现状与展望[J]. 华西医学, 2024, 39(4): 640-644. [Xie M, Cui  KJ. Current status and prospects of cryoballoon ablation in first-line treatment of atrial fibrillation[J]. West China Medical Journal, 2024, 39(4): 640-644.] DOI: 10.7507/1002-0179.202309152.