Atrial fibrillation and flutter in the Eastern Mediterranean: burden, disparities, and risk factor contributions from 1990 to 2021

TL;DR

Atrial fibrillation and flutter rates in the Eastern Mediterranean region have risen sharply from 1990 to 2021, driven by high blood pressure and obesity.

Contribution

This study quantifies the growing burden of atrial fibrillation and flutter in the Eastern Mediterranean and identifies key risk factors.

Findings

The incidence and prevalence of AFF increased by 161.9% in the EMR from 1990 to 2021.

High systolic blood pressure was the leading risk factor for AFF-related disability in 2021.

Women experienced greater increases in AFF rates compared to men across all age groups.

Abstract

Atrial fibrillation and flutter (AFF) are two of the most common cardiac tachyarrhythmias. The burden of AFF is increasing globally, with a particularly rapid increase in the Eastern Mediterranean region (EMR) due to economic and lifestyle changes. Despite extensive research on AFF, regional variations remain understudied.

To analyze the burden and risk factors for AFF in the EMR using the Global Burden of Disease (GBD).

Systematic analysis.

Data from the GBD 2021 were used to evaluate the incidence, prevalence, disability-adjusted life years (DALYs), and deaths associated with AFF stratified by age, sex, and sociodemographic index (SDI) from 1990 to 2021. In addition, deaths and DALYs of AFF attributable to risk factors were estimated. Accompanying 95% uncertainty intervals (UIs) were provided to reflect the combination of data and estimates, and findings were presented as absolute counts and age-standardized rates.

From 1990 to 2021, the absolute number of incidence and prevalence of AFF in the EMR increased by 161.9% (from 64362.4 [48684.7–85763.7] in 1990 to 168555.0 [129706.9–220844.2] in 2021) and 162.4% (from 617721.6 [482076.0–807810.5] in 1990 to 1620763.1 [1270893.6–2108347.5] in 2021), respectively. From 1990 to 2021, the EMR revealed significant increases in the age-standardized incidence (3.0%, 95% UI 1.1–4.8) and prevalence (4.6%, 2.9–6.3) of AFF, with women experiencing greater increases than men did. The burden of AFF increased across all ages, with the incidence increasing by 161.9% and the prevalence increasing by 162.4%. From 2019 to 2021, the age-standardized rates of incidence, prevalence, DALYs, and deaths remained stable, with no significant changes. High systolic blood pressure was the leading risk factor, contributing to 25.5 age-standardized DALYs per 100,000 in 2021, whereas a high body mass index showed the largest increase in the attributable burden. Compared with low-SDI nations, high-SDI countries presented higher prevalence and incidence rates but lower death rates. Age-specific analysis revealed a sharp increase in the AFF burden with age, particularly among women aged 95+ years.

The burden of AFF in the EMR increased from 1990 to 2021, with increasing incidence, DALY, and death rates. High systolic blood pressure and high body mass index are key contributors to these conditions. These findings underscore the need for public health interventions, including improved hypertension and obesity management, lifestyle modifications, and early detection strategies.

The online version contains supplementary material available at 10.1186/s43044-025-00693-5.

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