# Three decades of atrial fibrillation and flutter epidemiology and risk factors in Iran with a focus on the impact of COVID-19

## TL;DR

This study examines the rising burden of atrial fibrillation/flutter in Iran from 1990 to 2021, including the impact of the COVID-19 pandemic.

## Contribution

The study provides the first comprehensive analysis of AF/AFL trends in Iran using GBD 2021 data, including the effects of the pandemic.

## Key findings

- AF/AFL incidence and prevalence in Iran have significantly increased over three decades.
- High systolic blood pressure was the leading risk factor for AF/AFL-related DALYs and deaths.
- The burden of AF/AFL increased with age, and gender differences were observed in incidence, prevalence, DALYs, and deaths.

## Abstract

Atrial fibrillation/flutter (AF/AFL) is one of the most common sustained heart rhythm disorders in clinical practice and a major public health concern. This study aimed to evaluate the disease burden of AF/AFL in Iran and analyze trends using the Global Burden of Disease (GBD) 2021 data, by age, sex, location, risk factor, and socio-demographic index (SDI), considering the impacts of COVID-19. Data on the prevalence, incidence, disability-adjusted life years (DALYs), deaths, and six attributable risk factors related to AF/AFL in Iran and its 31 provinces from 1990 to 2021 was collected from the GBD 2021 study. The International Classification of Disease (ICD) codes used were I48–48.9 for ICD-10 and 427.3 for ICD-9. The data was sourced from surveys, censuses, vital statistics, and other health-related records. In Iran, in 2021, the AF/AFL age-standardized incidence rate (ASIR) was 40.6 (30.0 to 54.4), the age-standardized prevalence rate (ASPR) was 425.4 (327.2 to 559.2), the age-standardized DALY rate was 72.4 (57.4 to 88.3), and the age-standardized death rate (ASDR) was 3.3 (2.5 to 3.8) per 100,000 population. Following COVID-19, there were significant decreases in age-standardized DALY and death rates over 2019–2021. By province, Fars had the highest AF/AFL ASIR and ASPR in 2021. In addition, East and West Azarbayejan had the highest age-standardized DALY rate and ASDR, respectively. The national incidence, prevalence, DALYs, and death rates of AF/AFL showed an overall increasing trend with age. Males experienced higher rates of incidence and prevalence compared to females. In contrast, females had higher rates of DALYs and deaths compared to males. The burden of AF/AFL increased with advancing age. The risk factor with the highest DALYs and deaths attributable to AF/AFL was high systolic blood pressure. Notably, no remarkable association was found between SDI and the burden of AF/AFL in Iran. The incidence and prevalence of AF/AFL in Iran have significantly increased, highlighting the critical need for cost-effective and nationwide interventions.

The online version contains supplementary material available at 10.1038/s41598-025-91737-y.