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    • In the s several hospital based

    2019-06-19

    In the 1990s, several hospital-based surveys were reported. In a survey of AF among 2686 acute medical admissions to a district general hospital in Glasgow, UK [4], the prevalence of AF was 6.3%, with the predominant associated medical conditions being ischemic heart disease, hypertension, and valvular disease. A similar prospective survey of acute medical admissions over 6 months in West Birmingham, UK, in a multi-ethnic population, showed a lower prevalence of AF (2.3% in 7451 patients) [5]. In another report from New Zealand in 1999, the prevalence of AF was 10.4% in 1637 acutely ill patients admitted to the general medical service at the Auckland Hospital over a 12-week period [6]. Certain discrepancies between the frequencies of AF determined by surveys of ECG recordings and those reported in clinical practice were pointed out in a former report [1]. One of the reasons proposed was that hospital records were primarily taken from patients suspected of having cardiac disorders [1]. Other factors include whether the patients were admitted to the hospital or taken to the outpatient clinic, and whether the patients were in a general hospital or in a specialized cardiology unit. The year that the survey was conducted and the age of participants are also important factors that may contribute to discrepancies in the prevalence of AF among the surveys. In 2000, the Hokkaido Atrial Fibrillation Study Group reported that the prevalence of AF was 14% in 19,825 patients who visited the cardiovascular clinics of the 13 hospitals in Hokkaido, Japan [7]. Similarly, according to the Shinken Database 2004, including 2412 patients who first visited the Cardiovascular Institute in Tokyo, Japan, AF was found in 286 patients, for a frequency of 11.8% [8]. These results indicated that the frequency of AF reported in specialized cardiology units is higher than that in general hospitals. In the study conducted in Hokkaido [7], the age-specific prevalence of AF was 3.5% in patients younger than 40 years, 6.9% at ages 40–49 years, 10.4% at 50–59 years, 13.5% at 60–69 years, 18.7% at 70–79 years, and 25.4% in patients who were 80 years old or older. This trend was similar to that formerly reported [3], and all the prevalence rates were higher in the cardiovascular clinics than in the general facilities [3]. In a study among residents aged 65 years or older at the north end of Kyoto Prefecture, Japan, in 2006–2007, the prevalence of AF in outpatients of the phosphatase inhibitor clinic was 10.0%, whereas that found among residents who had ECGs as part of a annual resident check-up was 2.1% [9]. Thus, even in the same medical service area, the prevalence of AF was higher in patients examined in medical institutions than those examined in health check-up. The same trend in the age-specific prevalence of AF was observed in the elderly. It was 6.2% in those aged 65–74 years, 8.6% at 75–84 years, and 11.7% at 85 years or older [9].
    Population studies
    Incidence and projected number of AF cases Several epidemiological studies have reported the incidence of AF in Western counties. In the Framingham study [27], chronic and transient AF was identified in 26 in men and 16 in women aged 70–79 years per 1000 people during a follow-up period of 2 years; thus, the overall incidence of AF was 0.2% per year in men, and the highest rate was in subjects in their 70s (Fig. 4). In the Cardiovascular Health Study [28], among 4844 participants, 304 developed a first episode of AF during an average follow-up of 3.28 years, for an incidence of 19.2 per 1000 person-years. For men 65–74 and 75–84 years old, the incidence rates were 17.6 and 42.7, respectively, and for women, there were 10.1 and 21.6 events per 1000 person-years, indicating that the incidence of AF in adults increased with age. A community-based study with 4618 adult residents of Olmsted County, Minnesota [29] also showed that the incidence of AF increased with age, and was higher in older adults than in younger adults, similar to the Framingham study [30] and the Cardiovascular Health Study (Fig. 5) [28]. The age- and sex-adjusted incidence rates of AF per 1000 person-years were 3.04 in 1980 and 3.68 in 2000. Therefore, the incidence of AF in the overall cohort increased significantly, with a relative increase of 12.6% over 21 years [29]. If this increasing rate of incidence continues, the number of people with AF is projected to reach 15.9 million by 2050. Even if the age-adjusted incidence of AF remains the same as that in 2000, the number of people with AF would still be estimated to be 12.1 million (Fig. 6). The projected number of individuals who will develop AF by 2050 in the study in Minnesota [29] was much greater than the 5.6 million predicted in 2050 in the study by Feinberg et al. [17]. In 2009, Naccarelli et al. [31] reported an updated estimate of the prevalence of AF using a phosphatase inhibitor larger database of 21.6 million people of all ages. The number of people with AF in 2005 was estimated to be 3.03 million, and was projected to grow to 4.78 million in 2035 and 7.56 million in 2050. These estimates were larger than those projected by Go et al. [16] but smaller than those of Miyasaka et al. [29]. The possible reasons for the differences in the projected prevalence of AF among these studies include differences in sample sizes, geographical areas, and assumptions regarding the increases in the incidence of AF [31].