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  • Review Article
  • Published:

Global epidemiology of atrial fibrillation

An Erratum to this article was published on 14 July 2016

This article has been updated

Key Points

  • Atrial fibrillation (AF) is a worldwide epidemic affecting approximately 33 million people, and its rising prevalence is expected to account for increasing clinical and public health costs

  • Australia, Europe, and the USA have the highest reported prevalence of AF (1% in the adult population), but the prevalence of AF in low-income and middle-income countries is probably underestimated

  • AF is associated with an increased risk of myocardial infarction, heart failure, stroke, dementia, and chronic kidney disease, as well as increased mortality

  • Treatment of patients with AF is inadequate: <50% of those at high thromboembolic risk receive anticoagulation therapy worldwide

  • The dearth of data on the prevalence, lifetime risk, prognosis, prevention, treatment, and economic implications of AF in many regions around the world remains to be addressed

Abstract

Atrial fibrillation (AF) is a major public health burden worldwide, and its prevalence is set to increase owing to widespread population ageing, especially in rapidly developing countries such as Brazil, China, India, and Indonesia. Despite the availability of epidemiological data on the prevalence of AF in North America and Western Europe, corresponding data are limited in Africa, Asia, and South America. Moreover, other observations suggest that the prevalence of AF might be underestimated—not only in low-income and middle-income countries, but also in their high-income counterparts. Future studies are required to provide precise estimations of the global AF burden, identify important risk factors in various regions worldwide, and take into consideration regional and ethnic variations in AF. Furthermore, in response to the increasing prevalence of AF, additional resources will need to be allocated globally for prevention and treatment of AF and its associated complications. In this Review, we discuss the available data on the global prevalence, risk factors, management, financial costs, and clinical burden of AF, and highlight the current worldwide inadequacy of its treatment.

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Figure 1: Global prevalence of AF.37
Figure 2: Risk factors for atrial fibrillation.
Figure 3: Global use of antithrombotic therapy.

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Change history

  • 14 July 2016

    In the version of this article originally published online and in print, 'Prevalence of AF' on the y-axis in Figure 1 was incorrectly labelled as being in units of x103 instead of x106. Also, the section on 'Prevalence' in the main text incorrectly referred to an increase in AF from 8.8 million to 18 million in "Europe" rather than "the European Union". Both errors have been corrected in the HTML and PDF versions of the article.

References

  1. Einthoven, W. Le telecardiogramme [French]. Arch. Int. Physiol. 4, 132–164 (1906).

    Google Scholar 

  2. Lewis, T. Report CXIX. Auricular fibrillation: a common clinical condition. Br. Med. J. 2, 1528 (1909).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Piccini, J. P. et al. Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993–2007. Circ. Cardiovasc. Qual. Outcomes 5, 85–93 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Friberg, L. & Bergfeldt, L. Atrial fibrillation prevalence revisited. J. Intern. Med. 274, 461–468 (2013).

    Article  CAS  PubMed  Google Scholar 

  5. Krijthe, B. P. et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur. Heart J. 34, 2746–2751 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sturm, J. W., Davis, S. M., O'Sullivan, J. G., Vedadhaghi, M. E. & Donnan, G. A. The Avoid Stroke as Soon as Possible (ASAP) general practice stroke audit. Med. J. Aust. 176, 312–316 (2002).

    Article  PubMed  Google Scholar 

  7. Deif, B., Lowres, N. & Freedman, S. B. Screening for atrial fibrillation above age 65 detects an asymptomatic subset at high risk of stroke. Int. J. Cardiol. 164, 371–372 (2013).

    Article  PubMed  Google Scholar 

  8. Friberg, L. et al. Population screening of 75- and 76-year-old men and women for silent atrial fibrillation (STROKESTOP). Europace 15, 135–140 (2013).

    Article  PubMed  Google Scholar 

  9. Fitzmaurice, D. A. et al. Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial. BMJ 335, 383 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lowres, N., Neubeck, L., Redfern, J. & Freedman, S. B. Screening to identify unknown atrial fibrillation. A systematic review. Thromb. Haemost. 110, 213–222 (2013).

    Article  CAS  PubMed  Google Scholar 

  11. Stewart, S., Hart, C. L., Hole, D. J. & McMurray, J. J. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am. J. Med. 113, 359–364 (2002).

    Article  PubMed  Google Scholar 

  12. Lip, G. Y., Nieuwlaat, R., Pisters, R., Lane, D. A. & Crijns, H. J. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest 137, 263–272 (2010).

    Article  PubMed  Google Scholar 

  13. Soliman, E. Z. et al. Atrial fibrillation and the risk of myocardial infarction. JAMA Intern. Med. 174, 107–114 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Miyasaka, Y. et al. Coronary ischemic events after first atrial fibrillation: risk and survival. Am. J. Med. 120, 357–363 (2007).

    Article  PubMed  Google Scholar 

  15. Miyasaka, Y. et al. Incidence and mortality risk of congestive heart failure in atrial fibrillation patients: a community-based study over two decades. Eur. Heart J. 27, 936–941 (2006).

    Article  PubMed  Google Scholar 

  16. Kwok, C. S., Loke, Y. K., Hale, R., Potter, J. F. & Myint, P. K. Atrial fibrillation and incidence of dementia: a systematic review and meta-analysis. Neurology 76, 914–922 (2011).

    Article  CAS  PubMed  Google Scholar 

  17. Udompanich, S., Lip, G. Y., Apostolakis, S. & Lane, D. A. Atrial fibrillation as a risk factor for cognitive impairment: a semi-systematic review. QJM 106, 795–802 (2013).

    Article  CAS  PubMed  Google Scholar 

  18. Bansal, N. et al. Incident atrial fibrillation and risk of end-stage renal disease in adults with chronic kidney disease. Circulation 127, 569–574 (2013).

    Article  PubMed  Google Scholar 

  19. Watanabe, H. et al. Close bidirectional relationship between chronic kidney disease and atrial fibrillation: the Niigata Preventive Medicine Study. Am. Heart J. 158, 629–636 (2009).

    Article  PubMed  Google Scholar 

  20. Benjamin, E. J. et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 98, 946–952 (1998).

    Article  CAS  PubMed  Google Scholar 

  21. Miyasaka, Y. et al. Mortality trends in patients diagnosed with first atrial fibrillation: a 21-year community-based study. J. Am. Coll. Cardiol. 49, 986–992 (2007).

    Article  PubMed  Google Scholar 

  22. Go, A. S. et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study. JAMA 285, 2370–2375 (2001).

    Article  CAS  PubMed  Google Scholar 

  23. The World Bank. Health, Nutrition and Population Data and Statistics [online], (2012).

  24. Moran, A. et al. Future cardiovascular disease in China: Markov model and risk factor scenario projections from the Coronary Heart Disease Policy Model-China. Circ. Cardiovasc. Qual. Outcomes 3, 243–252 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  25. Miyasaka, Y. et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 114, 119–125 (2006).

    Article  PubMed  Google Scholar 

  26. Kim, M. H., Johnston, S. S., Chu, B. C., Dalal, M. R. & Schulman, K. L. Estimation of total incremental health care costs in patients with atrial fibrillation in the United States. Circ. Cardiovasc. Qual. Outcomes 4, 313–320 (2011).

    Article  PubMed  Google Scholar 

  27. Chugh, S. S. et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 129, 837–847 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  28. Colilla, S. et al. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am. J. Cardiol. 112, 1142–1147 (2013).

    Article  PubMed  Google Scholar 

  29. Naccarelli, G. V., Varker, H., Lin, J. & Schulman, K. L. Increasing prevalence of atrial fibrillation and flutter in the United States. Am. J. Cardiol. 104, 1534–1539 (2009).

    Article  PubMed  Google Scholar 

  30. DeWilde, S., Carey, I. M., Emmas, C., Richards, N. & Cook, D. G. Trends in the prevalence of diagnosed atrial fibrillation, its treatment with anticoagulation and predictors of such treatment in UK primary care. Heart 92, 1064–1070 (2006).

    Article  CAS  PubMed  Google Scholar 

  31. Health & Social Care Information Centre. Quality and Outcomes Framework—2009–2010, England level [online], (2010).

  32. Majeed, A. Trends in the prevalence and management of atrial fibrillation in general practice in England and Wales, 1994–1998: analysis of data from the general practice research database. Heart 86, 284–288 (2001).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Stefansdottir, H., Aspelund, T., Gudnason, V. & Arnar, D. O. Trends in the incidence and prevalence of atrial fibrillation in Iceland and future projections. Europace 13, 1110–1117 (2011).

    Article  PubMed  Google Scholar 

  34. Ohsawa, M. et al. Rapid increase in estimated number of persons with atrial fibrillation in Japan: an analysis from national surveys on cardiovascular diseases in 1980, 1990 and 2000. J. Epidemiol. 15, 194–196 (2005).

    Article  PubMed  PubMed Central  Google Scholar 

  35. Inoue, H. et al. Prevalence of atrial fibrillation in the general population of Japan: an analysis based on periodic health examination. Int. J. Cardiol. 137, 102–107 (2009).

    Article  PubMed  Google Scholar 

  36. Zhou, Z. & Hu, D. An epidemiological study on the prevalence of atrial fibrillation in the Chinese population of mainland China. J. Epidemiol. 18, 209–216 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  37. United States Census Bureau. International Data Base [online], (2012).

  38. Tse, H. F. et al. Stroke prevention in atrial fibrillation—an Asian stroke perspective. Heart Rhythm 10, 1082–1088 (2013).

    Article  PubMed  Google Scholar 

  39. The World Bank. Low & middle income [online], (2014).

  40. Institute for Health Metrics and Evaluation. GBD Compare [online], (2013).

  41. Moran, A. et al. The epidemiology of cardiovascular diseases in sub-Saharan Africa: the Global Burden of Diseases, Injuries and Risk Factors 2010 Study. Prog. Cardiovasc. Dis. 56, 234–239 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  42. Sriharibabu, M., Himabindu, Y. & Kabir, Z. Rheumatic heart disease in rural south India: a clinico-observational study. J. Cardiovasc. Dis. Res. 4, 25–29 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  43. Flaker, G. C. et al. Asymptomatic atrial fibrillation: demographic features and prognostic information from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Am. Heart J. 149, 657–663 (2005).

    Article  PubMed  Google Scholar 

  44. Alhadramy, O. et al. Prevalence and predictors of paroxysmal atrial fibrillation on Holter monitor in patients with stroke or transient ischemic attack. Stroke 41, 2596–2600 (2010).

    Article  PubMed  Google Scholar 

  45. Kishore, A. et al. Detection of atrial fibrillation after ischemic stroke or transient ischemic attack: a systematic review and meta-analysis. Stroke 45, 520–526 (2014).

    Article  CAS  PubMed  Google Scholar 

  46. Senoo, K. et al. Progression to the persistent form in asymptomatic paroxysmal atrial fibrillation. Circ. J. 78, 1121–1126 (2014).

    Article  PubMed  Google Scholar 

  47. Glotzer, T. V. et al. Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke: report of the Atrial Diagnostics Ancillary Study of the MOde Selection Trial (MOST). Circulation 107, 1614–1619 (2003).

    Article  PubMed  Google Scholar 

  48. Ziegler, P. D. et al. Incidence of newly detected atrial arrhythmias via implantable devices in patients with a history of thromboembolic events. Stroke 41, 256–260 (2010).

    Article  PubMed  Google Scholar 

  49. Wong, J. & Fong, A. Prevalence of asymptomatic atrial fibrillation in Malaysian patients with hypertension. Med. J. Malaysia 68, 141–143 (2013).

    CAS  PubMed  Google Scholar 

  50. Marcus, G. M. et al. European ancestry as a risk factor for atrial fibrillation in African Americans. Circulation 122, 2009–2015 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  51. Sinner, M. F., Ellinor, P. T., Meitinger, T., Benjamin, E. J. & Kaab, S. Genome-wide association studies of atrial fibrillation: past, present, and future. Cardiovasc. Res. 89, 701–709 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Shen, A. Y. et al. Racial/ethnic differences in the prevalence of atrial fibrillation among older adults—a cross-sectional study. J. Natl Med. Assoc. 102, 906–913 (2010).

    Article  PubMed  Google Scholar 

  53. Hernandez, M. B., Asher, C. R., Hernandez, A. V. & Novaro, G. M. African American race and prevalence of atrial fibrillation: a meta-analysis. Cardiol. Res. Pract. 2012, 275624 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  54. Alonso, A. et al. Incidence of atrial fibrillation in whites and African-Americans: the Atherosclerosis Risk in Communities (ARIC) study. Am. Heart J. 158, 111–117 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  55. Dewland, T. A., Olgin, J. E., Vittinghoff, E. & Marcus, G. M. Incident atrial fibrillation among Asians, Hispanics, blacks, and whites. Circulation 128, 2470–2477 (2013).

    Article  PubMed  Google Scholar 

  56. Jensen, P. N., Thacker, E. L., Dublin, S., Psaty, B. M. & Heckbert, S. R. Racial differences in the incidence of and risk factors for atrial fibrillation in older adults: the cardiovascular health study. J. Am. Geriatr. Soc. 61, 276–280 (2013).

    Article  PubMed  Google Scholar 

  57. Lip, G. et al. A survey of atrial fibrillation in general practice: the West Birmingham Atrial Fibrillation Project. Br. J. Gen. Pract. 47, 285–289 (1997).

    CAS  PubMed  PubMed Central  Google Scholar 

  58. Lip, G. Y. et al. Atrial fibrillation amongst the IndoAsian general practice population. The West Birmingham Atrial Fibrillation Project. Int. J. Cardiol. 65, 187–192 (1998).

    Article  CAS  PubMed  Google Scholar 

  59. Lau, C. P. et al. Ethnic differences in atrial fibrillation identified using implanted cardiac devices. J. Cardiovasc. Electrophysiol. 24, 381–387 (2013).

    Article  PubMed  Google Scholar 

  60. Jeong, J. H. Prevalence of and risk factors for atrial fibrillation in Korean adults older than 40 years J. Korean Med. Sci. 20, 26–30 (2005).

    Article  PubMed  PubMed Central  Google Scholar 

  61. Kiatchoosakun, S., Pachirat, O., Chirawatkul, A., Choprapawan, C. & Tatsanavivat, P. Prevalence of cardiac arrhythmias in Thai community. J. Med. Assoc. Thai. 82, 727–733 (1999).

    CAS  PubMed  Google Scholar 

  62. Assantachai, P., Panchavinnin, P. & Pisalsarakij, D. An electrocardiographic survey of elderly Thai people in the rural community. J. Med. Assoc. Thai. 85, 1273–1279 (2002).

    PubMed  Google Scholar 

  63. Kawabata-Yoshihara, L. A. et al. Prevalence of electrocardiographic findings in elderly individuals: the SĂ£o Paulo Aging & Health Study. Arq. Bras. Cardiol. 93, 602–607 (2009).

    Article  PubMed  Google Scholar 

  64. Dewhurst, M. J. et al. Strikingly low prevalence of atrial fibrillation in elderly Tanzanians. J. Am. Geriatr. Soc. 60, 1135–1140 (2012).

    Article  PubMed  Google Scholar 

  65. Shavadia, J. et al. Clinical characteristics and outcomes of atrial fibrillation and flutter at the Aga Khan University Hospital, Nairobi: cardiovascular topics. Cardiovasc. J. Afr. 24, 6–9 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  66. Kaushal, S., DasGupta, D., Prashar, B. & Bhardwaj, A. Electrocardiographic manifestations of healthy residents of a tribal Himalayan village. J. Assoc. Physicians India 43, 15–16 (1995).

    CAS  PubMed  Google Scholar 

  67. Clinical Trials Registry—India. Panarrhythmia and Heart Failure Registry [online], (2012).

  68. Zubaid, M. et al. Gulf Survey of Atrial Fibrillation Events (Gulf SAFE): design and baseline characteristics of patients with atrial fibrillation in the Arab Middle East. Circ. Cardiovasc. Qual. Outcomes 4, 477–482 (2011).

    Article  PubMed  Google Scholar 

  69. Maru, M. Atrial fibrillation and embolic complications. East Afr. Med. J. 74, 3–5 (1997).

    CAS  PubMed  Google Scholar 

  70. Sliwa, K. et al. Predisposing factors and incidence of newly diagnosed atrial fibrillation in an urban African community: insights from the Heart of Soweto Study. Heart 96, 1878–1882 (2010).

    Article  PubMed  Google Scholar 

  71. Oldgren, J. et al. Variations in cause and management of atrial fibrillation in a prospective registry of 15 400 emergency department patients in 46 countries: the RE-LY Atrial Fibrillation Registry. Circulation 129, 1568–1576 (2014).

    Article  PubMed  Google Scholar 

  72. Iung, B. & Vahanian, A. Epidemiology of valvular heart disease in the adult. Nat. Rev. Cardiol. 8, 162–172 (2011).

    Article  PubMed  Google Scholar 

  73. Salam, A. M., AlBinali, H. A., Al-Mulla, A. W., Singh, R. & Al Suwaidi, J. Secular trends, treatments, and outcomes of Middle Eastern Arab and South Asian patients hospitalized with atrial fibrillation: insights from a 20-year registry in Qatar (1991–2010). Angiology 64, 498–504 (2013).

    Article  PubMed  Google Scholar 

  74. Lee, K. S. et al. Prevalence of atrial fibrillation in middle-aged people in Korea: the Korean Genome and Epidemiology Study. Korean Circ. J. 38, 601–605 (2008).

    Article  Google Scholar 

  75. Uyarel, H. et al. Incidence, prevalence, and mortality estimates for chronic atrial fibrillation in Turkish adults. Turk. Kardiyol. Dern. Ar. 36, 214–222 (2008).

    Google Scholar 

  76. Lloyd-Jones, D. M. et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 110, 1042–1046 (2004).

    Article  PubMed  Google Scholar 

  77. Heeringa, J. et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur. Heart J. 27, 949–953 (2006).

    Article  PubMed  Google Scholar 

  78. Lim, S. S. et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2224–2260 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  79. Kelly, T., Yang, W., Chen, C. S., Reynolds, K. & He, J. Global burden of obesity in 2005 and projections to 2030. Int. J. Obes. (Lond.) 32, 1431–1437 (2008).

    Article  CAS  Google Scholar 

  80. Wang, T. J. et al. Obesity and the risk of new-onset atrial fibrillation. JAMA 292, 2471–2477 (2004).

    Article  CAS  PubMed  Google Scholar 

  81. Wanahita, N. et al. Atrial fibrillation and obesity—results of a meta-analysis. Am. Heart J. 155, 310–315 (2008).

    Article  PubMed  Google Scholar 

  82. Frost, L., Hune, L. J. & Vestergaard, P. Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Am. J. Med. 118, 489–495 (2005).

    Article  PubMed  Google Scholar 

  83. Guize, L., Thomas, F., Bean, K., Benetos, A. & Pannier, B. Atrial fibrillation: prevalence, risk factors and mortality in a large French population with 15 years of follow-up [French]. Bull. Acad. Natl Med. 191, 791–803 (2007).

    PubMed  Google Scholar 

  84. Tsang, T. S. et al. Obesity as a risk factor for the progression of paroxysmal to permanent atrial fibrillation: a longitudinal cohort study of 21 years. Eur. Heart J. 29, 2227–2233 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  85. Zhang, X. et al. Association of obesity and atrial fibrillation among middle-aged and elderly Chinese. Int. J. Obes. (Lond.) 33, 1318–1325 (2009).

    Article  CAS  Google Scholar 

  86. Dublin, S. et al. Risk of new-onset atrial fibrillation in relation to body mass index. Arch. Intern. Med. 166, 2322–2328 (2006).

    Article  PubMed  Google Scholar 

  87. Watanabe, H. et al. Metabolic syndrome and risk of development of atrial fibrillation: the Niigata Preventive Medicine Study. Circulation 117, 1255–1260 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  88. Guijian, L. et al. Impact of body mass index on atrial fibrillation recurrence: a meta-analysis of observational studies. Pacing Clin. Electrophysiol. 36, 748–756 (2013).

    Article  PubMed  Google Scholar 

  89. Huxley, R. R. et al. Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis Risk in Communities (ARIC) study. Circulation 123, 1501–1508 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  90. Thacker, E. L. et al. Association of body mass index, diabetes, hypertension, and blood pressure levels with risk of permanent atrial fibrillation. J. Gen. Intern. Med. 28, 247–253 (2013).

    Article  PubMed  Google Scholar 

  91. Kakkar, A. K. et al. Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry. PLoS ONE 8, e63479 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  92. Liu, Y., Liu, H., Dong, L., Chen, J. & Guo, J. Prevalence of atrial fibrillation in hospitalized patients over 40 years old: ten-year data from the People's Hospital of Peking University. Acta Cardiol. 65, 221–224 (2010).

    Article  PubMed  Google Scholar 

  93. Conen, D. et al. Influence of systolic and diastolic blood pressure on the risk of incident atrial fibrillation in women. Circulation 119, 2146–2152 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  94. Mitchell, G. F. et al. Pulse pressure and risk of new-onset atrial fibrillation. JAMA 297, 709–715 (2007).

    Article  CAS  PubMed  Google Scholar 

  95. Gamra, H. et al. Use of antithrombotics in atrial fibrillation in Africa, Europe, Asia and South America: insights from the International RealiseAF Survey. Arch. Cardiovasc. Dis. 107, 77–87 (2014).

    Article  PubMed  Google Scholar 

  96. Chiang, C.-E. et al. Distribution and risk profile of paroxysmal, persistent, and permanent atrial fibrillation in routine clinical practice: insight from the real-life global survey evaluating patients with atrial fibrillation international registry. Circ. Arrhythm. Electrophysiol. 5, 632–639 (2012).

    Article  PubMed  Google Scholar 

  97. Alonso, A. et al. Simple risk model predicts incidence of atrial fibrillation in a racially and geographically diverse population: the CHARGE-AF consortium. J. Am. Heart Assoc. 2, e000102 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  98. Krahn, A. D., Manfreda, J., Tate, R. B., Mathewson, F. A. & Cuddy, T. E. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am. J. Med. 98, 476–484 (1995).

    Article  CAS  PubMed  Google Scholar 

  99. Goto, S. et al. Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis. Am. Heart J. 156, 855–863 (2008).

    Article  PubMed  Google Scholar 

  100. Schnabel, R. B. et al. Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. Lancet 373, 739–745 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  101. Uchiyama, S. et al. Risk factor profiles of stroke, myocardial infarction, and atrial fibrillation: a Japanese Multicenter Cooperative Registry. J. Stroke Cerebrovasc. Dis. 19, 190–197 (2010).

    Article  PubMed  Google Scholar 

  102. Jabre, P. et al. Atrial fibrillation and death after myocardial infarction: a community study. Circulation 123, 2094–2100 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  103. Jabre, P. et al. Mortality associated with atrial fibrillation in patients with myocardial infarction: a systematic review and meta-analysis. Circulation 123, 1587–1593 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  104. Iguchi, Y. et al. Prevalence of atrial fibrillation in community-dwelling Japanese aged 40 years or older in Japan: analysis of 41,436 non-employee residents in Kurashiki-city. Circ. J. 72, 909–913 (2008).

    Article  PubMed  Google Scholar 

  105. Kannel, W. B., Abbott, R. D., Savage, D. D. & McNamara, P. M. Epidemiologic features of chronic atrial fibrillation: the Framingham study. N. Engl. J. Med. 306, 1018–1022 (1982).

    Article  CAS  PubMed  Google Scholar 

  106. Ntep-Gweth, M. et al. Atrial fibrillation in Africa: clinical characteristics, prognosis, and adherence to guidelines in Cameroon. Europace 12, 482–487 (2010).

    Article  PubMed  Google Scholar 

  107. Hersi, A. et al. Saudi Atrial Fibrillation Survey: national, observational, cross-sectional survey evaluating atrial fibrillation management and the cardiovascular risk profile of patients with atrial fibrillation. Angiology http://dx.doi.org/10.1177/0003319714529180.

  108. Bhardwaj, R. Atrial fibrillation in a tertiary care institute–a prospective study. Indian Heart J. 64, 476–478 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  109. Cappola, A. R. et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA 295, 1033–1041 (2006).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  110. Selmer, C. et al. The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study. BMJ 345, e7895 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  111. Kodama, S. et al. Alcohol consumption and risk of atrial fibrillation: a meta-analysis. J. Am. Coll. Cardiol. 57, 427–436 (2011).

    Article  CAS  PubMed  Google Scholar 

  112. Aviles, R. J. et al. Inflammation as a risk factor for atrial fibrillation. Circulation 108, 3006–3010 (2003).

    Article  PubMed  Google Scholar 

  113. Marott, S. C. et al. Does elevated C-reactive protein increase atrial fibrillation risk? A Mendelian randomization of 47,000 individuals from the general population. J. Am. Coll. Cardiol. 56, 789–795 (2010).

    Article  PubMed  Google Scholar 

  114. Schnabel, R. B. et al. Relations of biomarkers of distinct pathophysiological pathways and atrial fibrillation incidence in the community. Circulation 121, 200–207 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  115. Ofman, P. et al. Regular physical activity and risk of atrial fibrillation: a systematic review and meta-analysis. Circ. Arrhythm. Electrophysiol. 6, 252–256 (2013).

    Article  PubMed  Google Scholar 

  116. Aizer, A. et al. Relation of vigorous exercise to risk of atrial fibrillation. Am. J. Cardiol. 103, 1572–1577 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  117. Mozaffarian, D., Furberg, C. D., Psaty, B. M. & Siscovick, D. Physical activity and incidence of atrial fibrillation in older adults: the Cardiovascular Health Study. Circulation 118, 800–807 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  118. Arnar, D. O. et al. Familial aggregation of atrial fibrillation in Iceland. Eur. Heart J. 27, 708–712 (2006).

    Article  PubMed  Google Scholar 

  119. Christophersen, I. E. et al. Familial aggregation of atrial fibrillation: a study in Danish twins. Circ. Arrhythm. Electrophysiol. 2, 378–383 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  120. Fox, C. S. et al. Parental atrial fibrillation as a risk factor for atrial fibrillation in offspring. JAMA 291, 2851–2855 (2004).

    Article  CAS  PubMed  Google Scholar 

  121. Zoller, B., Ohlsson, H., Sundquist, J. & Sundquist, K. High familial risk of atrial fibrillation/atrial flutter in multiplex families: a nationwide family study in Sweden. J. Am. Heart Assoc. 2, e003384 (2013).

    Article  PubMed Central  Google Scholar 

  122. Li, C. et al. Significant association of SNP rs2106261 in the ZFHX3 gene with atrial fibrillation in a Chinese Han GeneID population. Hum. Genet. 129, 239–246 (2011).

    Article  PubMed  Google Scholar 

  123. Shi, L. et al. Assessment of association of rs2200733 on chromosome 4q25 with atrial fibrillation and ischemic stroke in a Chinese Han population. Hum. Genet. 126, 843–849 (2009).

    Article  PubMed  Google Scholar 

  124. Ellinor, P. T. et al. Meta-analysis identifies six new susceptibility loci for atrial fibrillation. Nat. Genet. 44, 670–675 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  125. Rienstra, M., McManus, D. D. & Benjamin, E. J. Novel risk factors for atrial fibrillation: useful for risk prediction and clinical decision making? Circulation 125, e941–e946 (2012).

    PubMed  PubMed Central  Google Scholar 

  126. Gage, B. F. et al. Validation of clinical classification schemes for predicting stroke. JAMA 285, 2864–2870 (2001).

    Article  CAS  PubMed  Google Scholar 

  127. Schnabel, R. B. et al. Risk assessment for incident heart failure in individuals with atrial fibrillation. Eur. J. Heart Fail. 15, 843–849 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  128. Suzuki, S. et al. A new scoring system for evaluating the risk of heart failure events in Japanese patients with atrial fibrillation. Am. J. Cardiol. 110, 678–682 (2012).

    Article  PubMed  Google Scholar 

  129. Wang, T. J. et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation 107, 2920–2925 (2003).

    Article  PubMed  Google Scholar 

  130. Kawabata-Yoshihara, L. A. et al. Atrial fibrillation and dementia: results from the Sao Paulo Ageing & Health Study. Arq. Bras. Cardiol. 99, 1108–1114 (2012).

    Article  PubMed  Google Scholar 

  131. Stefansdottir, H. et al. Atrial fibrillation is associated with reduced brain volume and cognitive function independent of cerebral infarcts. Stroke 44, 1020–1025 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  132. Thacker, E. L. et al. Atrial fibrillation and cognitive decline: a longitudinal cohort study. Neurology 81, 119–125 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  133. Bjorck, S., Palaszewski, B., Friberg, L. & Bergfeldt, L. Atrial fibrillation, stroke risk, and warfarin therapy revisited: a population-based study. Stroke 44, 3103–3108 (2013).

    Article  CAS  PubMed  Google Scholar 

  134. Guo, Y. et al. Validation of contemporary stroke and bleeding risk stratification scores in non-anticoagulated Chinese patients with atrial fibrillation. Int. J. Cardiol. 168, 904–909 (2013).

    Article  PubMed  Google Scholar 

  135. Komatsu, T. et al. Relationship between CHA2DS2-VASc scores and ischemic stroke/cardiovascular events in Japanese patients with paroxysmal atrial fibrillation without receiving anticoagulant therapy. J. Cardiol. 59, 321–328 (2012).

    Article  PubMed  Google Scholar 

  136. Chen, X., Wang, H., Zhang, H. & Xiao, C. The prevalence survey and influential factors of atrial fibrillation in Taiyuan. Heart 97, A91–A92 (2011).

    Article  Google Scholar 

  137. Jorgensen, H. S., Nakayama, H., Reith, J., Raaschou, H. O. & Olsen, T. S. Acute stroke with atrial fibrillation. The Copenhagen Stroke Study. Stroke 27, 1765–1769 (1996).

    Article  CAS  PubMed  Google Scholar 

  138. McGrath, E. R. et al. Association of atrial fibrillation with mortality and disability after ischemic stroke. Neurology 81, 825–832 (2013).

    Article  PubMed  Google Scholar 

  139. Liao, J., Khalid, Z., Scallan, C., Morillo, C. & O'Donnell, M. Noninvasive cardiac monitoring for detecting paroxysmal atrial fibrillation or flutter after acute ischemic stroke: a systematic review. Stroke 38, 2935–2940 (2007).

    Article  PubMed  Google Scholar 

  140. Sen, S. et al. Racial-ethnic differences in stroke risk factors and subtypes: results of a prospective hospital-based registry. Int. J. Neurosci. 123, 568–574 (2013).

    Article  PubMed  Google Scholar 

  141. Hanchate, A. D., Schwamm, L. H., Huang, W. & Hylek, E. M. Comparison of ischemic stroke outcomes and patient and hospital characteristics by race/ethnicity and socioeconomic status. Stroke 44, 469–476 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  142. Mahajan, S. et al. Stroke at moderate altitude. J. Assoc. Physicians India 52, 699–702 (2004).

    CAS  PubMed  Google Scholar 

  143. Syed, N. et al. Ischemic stroke subtypes in Pakistan: the Aga Khan university stroke data bank. J. Pak. Med. Assoc. 53, 584–588 (2003).

    CAS  PubMed  Google Scholar 

  144. Walker, R. W. et al. Electrocardiographic assessment of coronary artery disease and stroke risk factors in rural and urban Tanzania: a case-control study. J. Stroke Cerebrovasc. Dis. 23, 315–320 (2013).

    Article  PubMed  Google Scholar 

  145. Tagawa, M. et al. Evaluating patients with acute ischemic stroke with special reference to newly developed atrial fibrillation in cerebral embolism. Pacing Clin. Electrophysiol. 30, 1121–1128 (2007).

    Article  PubMed  Google Scholar 

  146. Kimura, K., Minematsu, K., Yamaguchi, T. & Japan Multicenter Stroke Investigators Collaboration (J-MUSIC). Atrial fibrillation as a predictive factor for severe stroke and early death in 15,831 patients with acute ischaemic stroke. J. Neurol. Neurosurg. Psychiatry 76, 679–683 (2005).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  147. Birman-Deych, E., Radford, M. J., Nilasena, D. S. & Gage, B. F. Use and effectiveness of warfarin in Medicare beneficiaries with atrial fibrillation. Stroke 37, 1070–1074 (2006).

    Article  CAS  PubMed  Google Scholar 

  148. Brainin, M., Teuschl, Y. & Kalra, L. Acute treatment and long-term management of stroke in developing countries. Lancet Neurol. 6, 553–561 (2007).

    Article  PubMed  Google Scholar 

  149. Hori, M. et al. Dabigatran versus warfarin: effects on ischemic and hemorrhagic strokes and bleeding in Asians and non-Asians with atrial fibrillation. Stroke 44, 1891–1896 (2013).

    Article  CAS  PubMed  Google Scholar 

  150. Albertsen, I. E. et al. Risk of stroke or systemic embolism in atrial fibrillation patients treated with warfarin: a systematic review and meta-analysis. Stroke 44, 1329–1336 (2013).

    Article  CAS  PubMed  Google Scholar 

  151. Sanderson, S., Emery, J. & Higgins, J. CYP2C9 gene variants, drug dose, and bleeding risk in warfarin-treated patients: a HuGEnet™ systematic review and meta-analysis. Genet. Med. 7, 97–104 (2005).

    Article  CAS  PubMed  Google Scholar 

  152. Tham, L. S. et al. A warfarin-dosing model in Asians that uses single-nucleotide polymorphisms in vitamin K epoxide reductase complex and cytochrome P450 2C9. Clin. Pharmacol. Ther. 80, 346–355 (2006).

    Article  CAS  PubMed  Google Scholar 

  153. Pathare, A. et al. Warfarin pharmacogenetics: development of a dosing algorithm for Omani patients. J. Hum. Genet. 57, 665–669 (2012).

    Article  CAS  PubMed  Google Scholar 

  154. Soares, R. A. et al. CYP2C9 and VKORC1 polymorphisms are differently distributed in the Brazilian population according to self-declared ethnicity or genetic ancestry. Genet. Test. Mol. Biomarkers 16, 957–963 (2012).

    Article  CAS  PubMed  Google Scholar 

  155. Kimmel, S. E. et al. A pharmacogenetic versus a clinical algorithm for warfarin dosing. N. Engl. J. Med. 369, 2283–2293 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  156. Chan, S. L., Suo, C., Chia, K. S. & Teo, Y. Y. The population attributable fraction as a measure of the impact of warfarin pharmacogenetic testing. Pharmacogenomics 13, 1247–1256 (2012).

    Article  CAS  PubMed  Google Scholar 

  157. Perera, M. A. et al. Genetic variants associated with warfarin dose in African-American individuals: a genome-wide association study. Lancet 382, 790–796 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  158. Hartter, S., Yamamura, N., Stangier, J., Reilly, P. A. & Clemens, A. Pharmacokinetics and pharmacodynamics in Japanese and Caucasian subjects after oral administration of dabigatran etexilate. Thromb. Haemost. 107, 260–269 (2012).

    Article  CAS  PubMed  Google Scholar 

  159. Hori, M. et al. Efficacy and safety of dabigatran vs. warfarin in patients with atrial fibrillation—sub-analysis in Japanese population in RE-LY trial. Circ. J. 75, 800–805 (2011).

    Article  CAS  PubMed  Google Scholar 

  160. Liesenfeld, K. H. et al. Population pharmacokinetic analysis of the oral thrombin inhibitor dabigatran etexilate in patients with non-valvular atrial fibrillation from the RE-LY trial. J. Thromb. Haemost. 9, 2168–2175 (2011).

    Article  CAS  PubMed  Google Scholar 

  161. Reilly, P. A. et al. The effect of dabigatran plasma concentrations and patient characteristics on the frequency of ischemic stroke and major bleeding in atrial fibrillation patients: the RE-LY trial (Randomized Evaluation of Long-Term Anticoagulation Therapy). J. Am. Coll. Cardiol. 63, 321–328 (2014).

    Article  CAS  PubMed  Google Scholar 

  162. Lin, H. J. et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke 27, 1760–1764 (1996).

    Article  CAS  PubMed  Google Scholar 

  163. Marini, C. et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke 36, 1115–1119 (2005).

    Article  PubMed  Google Scholar 

  164. Wong, K. S. Risk factors for early death in acute ischemic stroke and intracerebral hemorrhage: a prospective hospital-based study in Asia. Asian Acute Stroke Advisory Panel. Stroke 30, 2326–2330 (1999).

    Article  CAS  PubMed  Google Scholar 

  165. Huang, Y. C. et al. The impact factors on the cost and length of stay among acute ischemic stroke. J. Stroke Cerebrovasc. Dis. 22, e152–158 (2013).

    Article  PubMed  Google Scholar 

  166. Gattellari, M., Goumas, C., Aitken, R. & Worthington, J. M. Outcomes for patients with ischaemic stroke and atrial fibrillation: the PRISM study (a Program of Research Informing Stroke Management). Cerebrovasc. Dis. 32, 370–382 (2011).

    Article  PubMed  Google Scholar 

  167. Lamassa, M. et al. Characteristics, outcome, and care of stroke associated with atrial fibrillation in Europe: data from a multicenter multinational hospital-based registry (The European Community Stroke Project). Stroke 32, 392–398 (2001).

    Article  CAS  PubMed  Google Scholar 

  168. Lin, S. et al. Characteristics, treatment and outcome of ischemic stroke with atrial fibrillation in a Chinese hospital-based stroke study. Cerebrovasc. Dis. 31, 419–426 (2011).

    Article  PubMed  Google Scholar 

  169. Hannon, N. et al. Improved late survival and disability after stroke with therapeutic anticoagulation for atrial fibrillation: a population study. Stroke 42, 2503–2508 (2011).

    Article  PubMed  Google Scholar 

  170. Sussman, M. et al. Impact of atrial fibrillation on stroke-related healthcare costs. J. Am. Heart Assoc. 2, e000479 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  171. Kalantarian, S., Stern, T. A., Mansour, M. & Ruskin, J. N. Cognitive impairment associated with atrial fibrillation: a meta-analysis. Ann. Intern. Med. 158, 338–346 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  172. Marzona, I. et al. Increased risk of cognitive and functional decline in patients with atrial fibrillation: results of the ONTARGET and TRANSCEND studies. CMAJ 184, E329–E336 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  173. Miyasaka, Y. et al. Risk of dementia in stroke-free patients diagnosed with atrial fibrillation: data from a community-based cohort. Eur. Heart J. 28, 1962–1967 (2007).

    Article  PubMed  Google Scholar 

  174. Damasceno, A. et al. The causes, treatment, and outcome of acute heart failure in 1006 Africans from 9 countries. Arch. Intern. Med. 172, 1386–1394 (2012).

    Article  CAS  PubMed  Google Scholar 

  175. Karaye, K. M. & Sani, M. U. Electrocardiographic abnormalities in patients with heart failure. Cardiovasc. J. Afr. 19, 22–25 (2007).

    Google Scholar 

  176. Ahmed, A. & Perry, G. J. Incident atrial fibrillation and mortality in older adults with heart failure. Eur. J. Heart Fail. 7, 1118–1121 (2005).

    Article  PubMed  Google Scholar 

  177. McManus, D. D. et al. Atrial fibrillation and outcomes in heart failure with preserved versus reduced left ventricular ejection fraction. J. Am. Heart Assoc. 2, e005694 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  178. Chamberlain, A. M., Redfield, M. M., Alonso, A., Weston, S. A. & Roger, V. L. Atrial fibrillation and mortality in heart failure: a community study. Circ. Heart Fail. 4, 740–746 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  179. Mamas, M. A. et al. A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure. Eur. J. Heart Fail. 11, 676–683 (2009).

    Article  PubMed  Google Scholar 

  180. Wasywich, C. A. et al. Atrial fibrillation and the risk of death in patients with heart failure: a literature-based meta-analysis. Intern. Med. J. 40, 347–356 (2010).

    Article  CAS  PubMed  Google Scholar 

  181. Dzudie, A. et al. Prognostic significance of ECG abnormalities for mortality risk in acute heart failure: insight from the Sub-Saharan Africa Survey of Heart Failure (THESUS-HF). J. Card. Fail. 20, 45–52 (2014).

    Article  PubMed  Google Scholar 

  182. Ruff, C. T. et al. Long-term cardiovascular outcomes in patients with atrial fibrillation and atherothrombosis in the REACH Registry. Int. J. Cardiol. 170, 413–418 (2014).

    Article  PubMed  Google Scholar 

  183. Lubitz, S. A. et al. Atrial fibrillation patterns and risks of subsequent stroke, heart failure, or death in the community. J. Am. Heart Assoc. 2, e000126 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  184. Chen, L. Y. et al. Atrial fibrillation and the risk of sudden cardiac death: the Atherosclerosis Risk in Communities Study and Cardiovascular Health Study. JAMA Intern. Med. 173, 29–35 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  185. Duncan, M. E., Pitcher, A. & Goldacre, M. J. Atrial fibrillation as a cause of death increased steeply in England between 1995 and 2010. Europace 16, 797–802 (2014).

    Article  PubMed  Google Scholar 

  186. Chien, K.-L. et al. Atrial fibrillation prevalence, incidence and risk of stroke and all-cause death among Chinese. Int. J. Cardiol. 139, 173–180 (2010).

    Article  PubMed  Google Scholar 

  187. Suzuki, S. et al. Prevalence and prognosis of patients with atrial fibrillation in Japan: a prospective cohort of Shinken Database 2004. Circ. J. 72, 914–920 (2008).

    Article  PubMed  Google Scholar 

  188. Fuster, V. et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114, e257–e354 (2006).

    Article  PubMed  Google Scholar 

  189. European Heart Rhythm Association et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur. Heart J. 31, 2369–2429 (2010).

  190. Wyse, D. et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N. Engl. J. Med. 347, 1825–1833 (2002).

    Article  CAS  PubMed  Google Scholar 

  191. Hagens, V. E. et al. Effect of rate or rhythm control on quality of life in persistent atrial fibrillation. Results from the Rate Control Versus Electrical Cardioversion (RACE) study. J. Am. Coll. Cardiol. 43, 241–247 (2004).

    Article  PubMed  Google Scholar 

  192. Nieuwlaat, R. et al. Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation. Eur. Heart. J. 26, 2422–2434 (2005).

    Article  PubMed  Google Scholar 

  193. Nabauer, M. et al. The Registry of the German Competence NETwork on Atrial Fibrillation: patient characteristics and initial management. Europace 11, 423–434 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  194. Wen-Hang, Q. I. Retrospective investigation of hospitalised patients with atrial fibrillation in mainland China. Int. J. Cardiol. 105, 283–287 (2005).

    Article  CAS  PubMed  Google Scholar 

  195. Zhang, S. Atrial fibrillation in mainland China: epidemiology and current management. Heart 95, 1052–1055 (2009).

    Article  CAS  PubMed  Google Scholar 

  196. Hu, D. & Sun, Y. Epidemiology, risk factors for stroke, and management of atrial fibrillation in China. J. Am. Coll. Cardiol. 52, 865–868 (2008).

    Article  PubMed  Google Scholar 

  197. Chen, Y. H., Chen, H., Wu, Y. & Hu, D. Cardiac electrophysiology in China. Heart Rhythm 4, 862 (2007).

    Article  PubMed  Google Scholar 

  198. Ruigomez, A., Johansson, S., Wallander, M. A. & Rodriguez, L. A. Incidence of chronic atrial fibrillation in general practice and its treatment pattern. J. Clin. Epidemiol. 55, 358–363 (2002).

    Article  PubMed  Google Scholar 

  199. Fang, M. C., Stafford, R. S., Ruskin, J. N. & Singer, D. E. National trends in antiarrhythmic and antithrombotic medication use in atrial fibrillation. Arch. Intern. Med. 164, 55–60 (2004).

    Article  PubMed  Google Scholar 

  200. Chang, S. S. et al. Digoxin use is associated with increased risk of stroke in patients with non-valvular atrial fibrillation—a nationwide population-based cohort study. Int. J. Cardiol. 169, e26–e27 (2013).

    Article  PubMed  Google Scholar 

  201. Cappato, R. et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ. Arrhythm. Electrophysiol. 3, 32–38 (2010).

    Article  PubMed  Google Scholar 

  202. Gupta, A. et al. Complications of catheter ablation of atrial fibrillation: a systematic review. Circ. Arrhythm. Electrophysiol. 6, 1082–1088 (2013).

    Article  PubMed  Google Scholar 

  203. Cappato, R. et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation 111, 1100–1105 (2005).

    Article  PubMed  Google Scholar 

  204. Laguna, P., Martín, A., del Arco, C. & Gargantilla, P. Risk factors for stroke and thromboprophylaxis in atrial fibrillation: what happens in daily clinical practice? The GEFAUR-1 study. Ann. Emerg. Med. 44, 3–11 (2004).

    Article  PubMed  Google Scholar 

  205. Scott, P. A. Prevalence of atrial fibrillation and antithrombotic prophylaxis in emergency department patients. Stroke 33, 2664–2669 (2002).

    Article  PubMed  Google Scholar 

  206. Andersen, K. K. & Olsen, T. S. Reduced poststroke mortality in patients with stroke and atrial fibrillation treated with anticoagulants: results from a Danish quality-control registry of 22,179 patients with ischemic stroke. Stroke 38, 259–263 (2007).

    Article  PubMed  Google Scholar 

  207. Apostolakis, S. et al. Assessment of stroke risk in Middle Eastern patients with atrial fibrillation: the Gulf SAFE registry. Int. J. Cardiol. 168, 1644–1646 (2013).

    Article  CAS  PubMed  Google Scholar 

  208. Fornari, L. S. et al. Misuse of antithrombotic therapy in atrial fibrillation patients: frequent, pervasive and persistent. J. Thromb. Thrombolysis 23, 65–71 (2007).

    Article  PubMed  Google Scholar 

  209. Lakshminarayan, K., Solid, C. A., Collins, A. J., Anderson, D. C. & Herzog, C. A. Atrial fibrillation and stroke in the general Medicare population: a 10-year perspective (1992 to 2002). Stroke 37, 1969–1974 (2006).

    Article  PubMed  Google Scholar 

  210. Marshall, I. J., Wang, Y., McKevitt, C., Rudd, A. G. & Wolfe, C. D. Trends in risk factor prevalence and management before first stroke: data from the South London Stroke Register 1995–2011. Stroke 44, 1809–1816 (2013).

    Article  PubMed  Google Scholar 

  211. Mathur, R. et al. Ethnicity and stroke risk in patients with atrial fibrillation. Heart 99, 1087–1092 (2013).

    Article  PubMed  Google Scholar 

  212. Gadzhanova, S. V., Roughead, E. E. & Bartlett, M. J. Improving cardiovascular disease management in Australia: NPS MedicineWise. Med. J. Aust. 199, 192–195 (2013).

    Article  PubMed  Google Scholar 

  213. Jedsadayanmata, A. Patterns and adherence to guidelines of antithrombotic therapy in Thai patients with nonvalvular atrial fibrillation. J. Med. Assoc. Thai. 96, 91–98 (2013).

    PubMed  Google Scholar 

  214. Tomita, F. et al. Prevalence and clinical characteristics of patients with atrial fibrillation: analysis of 20,000 cases in Japan. Jpn. Circ. J. 64, 653–658 (2000).

    Article  CAS  PubMed  Google Scholar 

  215. Atarashi, H. et al. Present status of anticoagulation treatment in Japanese patients with atrial fibrillation: a report from the J-RHYTHM Registry. Circ. J. 75, 1328–1333 (2011).

    Article  PubMed  Google Scholar 

  216. Singer, D. E. et al. Impact of global geographic region on time in therapeutic range on warfarin anticoagulant therapy: data from the ROCKET AF clinical trial. J. Am. Heart Assoc. 2, e000067 (2013).

    PubMed  PubMed Central  Google Scholar 

  217. Ghaswalla, P. K., Harpe, S. E. & Slattum, P. W. Warfarin use in nursing home residents: results from the 2004 national nursing home survey. Am. J. Geriatr. Pharmacother. 10, 25–36.e2 (2012).

    Article  CAS  PubMed  Google Scholar 

  218. Gao, Q. et al. Use of oral anticoagulation among stroke patients with atrial fibrillation in China: the ChinaQUEST (Quality Evaluation of Stroke Care and Treatment) registry study. Int. J. Stroke 8, 150–154 (2012).

    Article  Google Scholar 

  219. Maurice, M. F., Di Tommaso, F., Zgaig, M., Stutzbach, P. & Iglesias, R. Thromboprophylaxis of atrial fibrillation. Analysis of the Argentinean National Register of Atrial Fibrillation and Atrial Flutter (RENAFA) [abstract]. J. Cardiovasc. Electrophysiol. 22 (Suppl. 1), S102 (2011).

    Google Scholar 

  220. Man- Son-Hing, M., Nichol, G., Lau, A. & Laupacis, A. Choosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls. Arch. Intern. Med. 159, 677–685 (1999).

    Article  Google Scholar 

  221. Gattellari, M., Worthington, J., Zwar, N. & Middleton, S. Barriers to the use of anticoagulation for nonvalvular atrial fibrillation: a representative survey of Australian family physicians. Stroke 39, 227–230 (2008).

    Article  PubMed  Google Scholar 

  222. Donzé, J. et al. Risk of falls and major bleeds in patients on oral anticoagulation therapy. Am. J. Med. 125, 773–778 (2012).

    Article  PubMed  Google Scholar 

  223. Sellers, M. B. & Newby, L. K. Atrial fibrillation, anticoagulation, fall risk, and outcomes in elderly patients. Am. Heart J. 161, 241–246 (2011).

    Article  PubMed  Google Scholar 

  224. Fang, M. C. et al. Death and disability from warfarin-associated intracranial and extracranial hemorrhages. Am. J. Med. 120, 700–705 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  225. Suzuki, S. et al. Incidence of major bleeding complication of warfarin therapy in Japanese patients with atrial fibrillation. Circ. J. 71, 761–765 (2007).

    Article  CAS  PubMed  Google Scholar 

  226. Shen, A. Y., Yao, J. F., Brar, S. S., Jorgensen, M. B. & Chen, W. Racial/ethnic differences in the risk of intracranial hemorrhage among patients with atrial fibrillation. J. Am. Coll. Cardiol. 50, 309–315 (2007).

    Article  PubMed  Google Scholar 

  227. Ringborg, A. et al. Costs of atrial fibrillation in five European countries: results from the Euro Heart Survey on atrial fibrillation. Europace 10, 403–411 (2008).

    Article  PubMed  Google Scholar 

  228. Wattigney, W. A., Mensah, G. A. & Croft, J. B. Increasing trends in hospitalization for atrial fibrillation in the United States, 1985 through 1999: implications for primary prevention. Circulation 108, 711–716 (2003).

    Article  PubMed  Google Scholar 

  229. Wong, C. X., Brooks, A. G., Leong, D. P., Roberts-Thomson, K. C. & Sanders, P. The increasing burden of atrial fibrillation compared with heart failure and myocardial infarction: a 15-year study of all hospitalizations in Australia. Arch. Intern. Med. 172, 739–741 (2012).

    Article  PubMed  Google Scholar 

  230. Benjamin, E. J. et al. Prevention of atrial fibrillation: report from a National Heart, Lung, and Blood Institute workshop. Circulation 119, 606–618 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  231. Guthrie, B., Payne, K., Alderson, P., McMurdo, M. E. & Mercer, S. W. Adapting clinical guidelines to take account of multimorbidity. BMJ 345, e6341 (2012).

    Article  PubMed  Google Scholar 

  232. Piccini, J. P. et al. Clinical course of atrial fibrillation in older adults: the importance of cardiovascular events beyond stroke. Eur. Heart J. 35, 250–256 (2014).

    Article  PubMed  Google Scholar 

  233. Hess, P. L. et al. Use of evidence-based cardiac prevention therapy among outpatients with atrial fibrillation. Am. J. Med. 126, 625–632.e1 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  234. Hendriks, J. M. et al. Nurse-led care vs. usual care for patients with atrial fibrillation: results of a randomized trial of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation. Eur. Heart J. 33, 2692–2699 (2012).

    Article  PubMed  Google Scholar 

  235. Abed, H. S. et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA 310, 2050–2060 (2013).

    Article  CAS  PubMed  Google Scholar 

  236. McManus, D. D. et al. A novel application for the detection of an irregular pulse using an iPhone 4S in patients with atrial fibrillation. Heart Rhythm 10, 315–319 (2013).

    Article  PubMed  Google Scholar 

  237. Gradl, S., Kugler, P., Lohmuller, C. & Eskofier, B. Real-time ECG monitoring and arrhythmia detection using Android-based mobile devices. Conf. Proc. IEEE Eng. Med. Biol. Soc. 2012, 2452–2455 (2012).

    Google Scholar 

  238. Lau, J. K. et al. iPhone ECG application for community screening to detect silent atrial fibrillation: a novel technology to prevent stroke. Int. J. Cardiol. 165, 193–194 (2013).

    Article  PubMed  Google Scholar 

  239. Rosenberg, M. A., Samuel, M., Thosani, A. & Zimetbaum, P. J. Use of a noninvasive continuous monitoring device in the management of atrial fibrillation: a pilot study. Pacing Clin. Electrophysiol. 36, 328–333 (2013).

    Article  PubMed  Google Scholar 

  240. Hendrikx, T., Hornsten, R., Rosenqvist, M. & Sandstrom, H. Screening for atrial fibrillation with baseline and intermittent ECG recording in an out-of-hospital population. BMC Cardiovasc. Disord. 13, 41 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  241. The World Bank. GDP per capita, PPP (current international $) [online], (2013).

  242. Kirley, K., Qato, D. M., Kornfield, R., Stafford, R. S. & Alexander, G. C. National trends in oral anticoagulant use in the United States, 2007 to 2011. Circ. Cardiovasc. Qual. Outcomes 5, 615–621 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  243. Rasool, S. & Haq, Z. Anticoagulation therapy in high risk patients with atrial fibrillation: retrospective study in a regional hospital. JLUMHS 8, 136–138 (2009).

    Google Scholar 

  244. Arce, M. et al. Frecuencia de fibrilaciĂ³n auricular y tratamiento con anticoagulantes orales en pacientes con marcapasos definitivo [Spanish]. Invest. Clin. 52, 58–68 (2011).

    PubMed  Google Scholar 

  245. Habibzadeh, F., Yadollahie, M., Roshanipoor, M. & Haghighi, A. Prevalence of atrial fibrillation in a primary health care centre in Fars province, Islamic Republic of Iran. East Mediterr. Health J. 10, 147–151 (2004).

    CAS  PubMed  Google Scholar 

  246. Inoue, H. et al. Sex-related differences in the risk factor profile and medications of patients with atrial fibrillation recruited in J-TRACE. Circ. J. 74, 650–654 (2010).

    Article  PubMed  Google Scholar 

  247. Lee, S. H. et al. Risk factors between patients with lone and non-lone atrial fibrillation. J. Korean Med. Sci. 28, 1174–1180 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  248. Bennett, D., Abate, J. & Abrahamson, P. E. Characteristics of patients with venous thromboembolism and atrial fibrillation in Venezuela. BMC Public Health 11, 415 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  249. Weir, N., Sandercock, P., Lewis, S., Signorini, D. & Warlow, C. Variations between countries in outcome after stroke in the International Stroke Trial (IST). Stroke 32, 1370–1377 (2001).

    Article  CAS  PubMed  Google Scholar 

  250. GonzĂ¡lez Toledo, M. E. et al. Atrial fibrillation detected after acute ischemic stroke: evidence supporting the neurogenic hypothesis. J. Stroke Cerebrovasc. Dis. 22, e486–e491 (2013).

    Article  PubMed  Google Scholar 

  251. Mallmann, A. B., Fuchs, S. C., Gus, M., Fuchs, F. D. & Moreira, L. B. Population-attributable risks for ischemic stroke in a community in South Brazil: a case-control study. PLoS ONE 7, e35680 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  252. Ghandehari, K. & Mood, Z. I. Cardioembolic strokes in Eastern Iran and the importance of rheumatic valvular disease. Turk. J. Med. Sci. 36, 361–364 (2006).

    Google Scholar 

  253. Bahou, Y., Hamid, H. & Raqab, M. Z. Ischemic stroke in Jordan 2000 to 2002: a two-year, hospital-based study. J. Stroke Cerebrovasc. Dis. 13, 81–84 (2004).

    Article  PubMed  Google Scholar 

  254. Devkota, K. C., Thapamagar, S. B. & Malla, S. Retrospective analysis of stroke and its risk factors at Nepal Medical College Teaching Hospital. Nepal Med. Coll. J. 8, 269–275 (2006).

    PubMed  Google Scholar 

  255. Alkali, N. et al. Stroke risk factors, subtypes, and 30-day case fatality in Abuja, Nigeria. Niger. Med. J. 54, 129–135 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  256. Shafqat, S., Kelly, P. & Furie, K. Holter monitoring in the diagnosis of stroke mechanism. Intern. Med. J. 34, 305–309 (2004).

    Article  CAS  PubMed  Google Scholar 

  257. Deleu, D. et al. Ethnic variations in risk factor profile, pattern and recurrence of non-cardioembolic ischemic stroke. Arch. Med. Res. 37, 655–662 (2006).

    Article  PubMed  Google Scholar 

  258. Khan, F. Y. et al. Stroke in Qatar: a first prospective hospital-based study of acute stroke. J. Stroke Cerebrovasc. Dis. 17, 69–78 (2008).

    Article  PubMed  Google Scholar 

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All the authors contributed substantially to researching data for the article, discussion of content, writing, reviewing, and editing of the manuscript before submission.

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Rahman, F., Kwan, G. & Benjamin, E. Global epidemiology of atrial fibrillation. Nat Rev Cardiol 11, 639–654 (2014). https://doi.org/10.1038/nrcardio.2014.118

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