Netherlands Heart Journal

, Volume 19, Issue 9, pp 373–378 | Cite as

The burden of atrial fibrillation in the Netherlands

  • H. E. HeemstraEmail author
  • R. Nieuwlaat
  • M. Meijboom
  • H. J. Crijns
Original Article



Atrial fibrillation (AF) is the most common sustained atrial arrhythmia and it is independently associated with an increased morbidity and mortality. As a result of the high prevalence of AF, the economic and clinical impact of the disease is substantial. This study describes the economic and clinical impact of AF in the Netherlands.


Epidemiological data on AF in the Netherlands were projected on population estimates of the Netherlands in 2009 and combined with data on the cost of AF and its interventions.


Overall prevalence of AF in the Netherlands is 5.5% in the population over 55 years, corresponding to about 250,000 AF patients. The prevalence increases with age, and the mean age of AF patients is 69.3 years. Incidence of AF in the Netherlands varies with age, from 1188 new cases in the age group of 55 to 59 up to 7074 new cases in the age group 75 to 79. Total new cases amounts to 45,085 patients per year in the Netherlands. Total costs of AF in the Netherlands are € 583 million, of which the majority (70%) were accounted for by hospitalisations and in-hospital procedures. Pharmacotherapeutic management of AF totalled € 17 million in the Netherlands in 2009.


AF is a serious disease with a high clinical and economic burden, especially due to hospitalisations as a result of cardiovascular events. The number of patients with AF in the Netherlands is considerable and will increase with the ageing population in the future.


Atrial fibrillation Burden of illness Costs Comorbidity 



This study was funded by Sanofi-Aventis. The authors were independent from Sanofi-Aventis in the conduct and the reporting of this study.


  1. 1.
    Benjamin EJ, Levy D, Vaziri SM, et al. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994;271(11):840–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Kannel WB, Wolf PA, Benjamin EJ, et al. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol. 1998;82(8A):2N–9N.PubMedCrossRefGoogle Scholar
  3. 3.
    Stewart S, Hart CL, Hole DJ, et al. 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. 2002;113(5):359–64.PubMedCrossRefGoogle Scholar
  4. 4.
    Kirchhof P, Bax J, Blomstrom-Lundquist C, et al. Early and comprehensive management of atrial fibrillation: proceedings from the 2nd AFNET/EHRA consensus conference on atrial fibrillation entitled ‘research perspectives in atrial fibrillation’. Europace. 2009;11(7):860–85.PubMedCrossRefGoogle Scholar
  5. 5.
    Miyasaka Y, Barnes ME, Gersh BJ, 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. 2006;114(2):119–25.PubMedCrossRefGoogle Scholar
  6. 6.
    Nieuwlaat R, Capucci A, Camm AJ, et al. Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation. Eur Heart J. 2005;26(22):2422–34.PubMedCrossRefGoogle Scholar
  7. 7.
    McBride D, Mattenklotz AM, Willich SN, et al. The costs of care in atrial fibrillation and the effect of treatment modalities in Germany. Value Health. 2008;12(2):293–301.PubMedCrossRefGoogle Scholar
  8. 8.
    Moeremans K, Aliot E, de Chillou C, et al. Second line pharmacological management of paroxysmal and persistent atrial fibrillation in France: a cost analysis. Value Health. 2000;3(6):407–16.PubMedCrossRefGoogle Scholar
  9. 9.
    Stewart S, Murphy NF, Walker A, et al. Cost of an emerging epidemic: an economic analysis of atrial fibrillation in the UK. Heart. 2004;90(3):286–92.PubMedCrossRefGoogle Scholar
  10. 10.
    Reynolds MR, Essebag V, Zimetbaum P, et al. Healthcare resource utilization and costs associated with recurrent episodes of atrial fibrillation: the FRACTAL registry. J Cardiovasc Electrophysiol. 2007;18(6):628–33.PubMedCrossRefGoogle Scholar
  11. 11.
    Ringborg A, Nieuwlaat R, Lindgren P, et al. Costs of atrial fibrillation in five European countries: results from the Euro Heart Survey on atrial fibrillation. Europace. 2008;10(4):403–11.PubMedCrossRefGoogle Scholar
  12. 12.
    Camm AJ, Kirchhof P, Lip GY, 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). European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery. Eur Heart J. 2010;31(19):2369–429.PubMedCrossRefGoogle Scholar
  13. 13.
    Benjamin EJ, Wolf PA, D’Agostino RB, et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998;98(10):946–52.PubMedGoogle Scholar
  14. 14.
    Rho RW, Page RL. Asymptomatic atrial fibrillation. Prog Cardiovasc Dis. 2005;48(2):79–87.PubMedCrossRefGoogle Scholar
  15. 15.
    Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001;285(22):2864–70.PubMedCrossRefGoogle Scholar
  16. 16.
    Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Go AS, Hylek EM, Phillips KA, 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. 2001;285(18):2370–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Lin HJ, Wolf PA, Kelly-Hayes M, et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27(10):1760–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Sandercock P, Bamford J, Dennis M, et al. Atrial fibrillation and stroke: prevalence in different types of stroke and influence on early and long term prognosis (Oxfordshire community stroke project). BMJ. 1992;305(6867):1460–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Marini C, De Santis F, Sacco S, et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke. 2005;36(6):1115–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Kaarisalo MM, Immonen-Räihä P, Marttila RJ, et al. Atrial fibrillation and stroke. Mortality and causes of death after the first acute ischemic stroke. Stroke. 1997;28(2):311–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Efremidis M, Pappas L, Sideris A, et al. Management of atrial fibrillation in patients with heart failure. J Card Fail. 2008;14(3):232–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Wang TJ, Larson MG, Levy D, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003;107(23):2920–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Nieuwlaat R, Prins MH, Le Heuzey JY, et al. Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on atrial fibrillation. Eur Heart J. 2008;29(9):1181–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Conen D, Osswald S, Albert CM. Epidemiology of atrial fibrillation. Swiss Med Wkly. 2009;139(25–26):346–52.PubMedGoogle Scholar
  26. 26.
    Healey JS, Connolly SJ. Atrial fibrillation: hypertension as a causative agent, risk factor for complications, and potential therapeutic target. Am J Cardiol. 2003;91(10A):9G–14G.PubMedCrossRefGoogle Scholar
  27. 27.
    Heeringa J, van der Kuip DA, Hofman A, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J. 2006;27(8):949–53.PubMedCrossRefGoogle Scholar
  28. 28.
    Reynolds MR, Ellis E, Zimetbaum P. Quality of life in atrial fibrillation: measurement tools and impact of interventions. J Cardiovasc Electrophysiol. 2008;19(7):762–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Kang Y. Relation of atrial arrhythmia-related symptoms to health-related quality of life in patients with newly diagnosed atrial fibrillation: a community hospital-based cohort. Heart Lung. 2006;35(3):170–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Howes CJ, Reid MC, Brandt C, et al. Exercise tolerance and quality of life in elderly patients with chronic atrial fibrillation. J Cardiovasc Pharmacol Ther. 2001;6(1):23–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Reynolds MR, Lavelle T, Essebag V, et al. Influence of age, sex, and atrial fibrillation recurrence on quality of life outcomes in a population of patients with new-onset atrial fibrillation: the Fibrillation Registry Assessing Costs, Therapies, Adverse events and Lifestyle (FRACTAL) study. Am Heart J. 2006;152(6):1097–103.PubMedCrossRefGoogle Scholar
  32. 32.
    Furberg CD, Psaty BM, Manolio TA, et al. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Am J Cardiol. 1994;74(3):236–41.PubMedCrossRefGoogle Scholar
  33. 33.
    Nederlands Huisartsen Genootschap. NHG-standaard atriumfibrilleren M79. 2009. Available from: Accessed 23 Dec 2009.
  34. 34.
    Corley SD, Epstein AE, DiMarco JP, et al. Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study. Circulation. 2004;109(12):1509–13.PubMedCrossRefGoogle Scholar
  35. 35.
    Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347(23):1825–33.PubMedCrossRefGoogle Scholar
  36. 36.
    Burkhardt JD, Natale A. New technologies in atrial fibrillation ablation. Circulation. 2009;120(15):1533–41.PubMedCrossRefGoogle Scholar
  37. 37.
    Fisher JD, Spinelli MA, Mookherjee D, et al. Atrial fibrillation ablation: reaching the mainstream. Pacing Clin Electrophysiol. 2006;29(5):523–37.PubMedCrossRefGoogle Scholar
  38. 38.
    Ehrlich JR, Nattel S. Novel approaches for pharmacological management of atrial fibrillation. Drugs. 2009;69(7):757–74.PubMedCrossRefGoogle Scholar
  39. 39.
    Gezondheid en zorg in cijfers 2009. Centraal Bureau voor de Statistiek. Dec 2009. Available from: Accessed 5 Jan 2010.
  40. 40.
    College voor Zorgverzekeringen. Accessed 5 Jan 2010.

Copyright information

© Springer Media / Bohn Stafleu van Loghum 2011

Authors and Affiliations

  • H. E. Heemstra
    • 1
    Email author
  • R. Nieuwlaat
    • 2
  • M. Meijboom
    • 1
  • H. J. Crijns
    • 3
  1. 1.Pharmerit InternationalRotterdamthe Netherlands
  2. 2.Population Health Research Institute, Hamilton Health SciencesMcMaster UniversityHamiltonCanada
  3. 3.Maastricht University Medical CentreMaastrichtthe Netherlands

Personalised recommendations