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Short Stay Management of Atrial Fibrillation pp 3–17Cite as

Atrial Fibrillation: Epidemiology and Demographics

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Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

In the clinical setting, atrial fibrillation (AF) is the most commonly presented arrhythmia of clinical significance. It is estimated that it affects 46.1 million people globally. Up to a half-million hospitalizations annually in the USA have AF as their primary diagnosis, and AF is estimated to contribute to >100,000 deaths per year in the USA. AF has a significant impact on health-care costs, with the major cost drivers being hospitalizations, stroke, and loss of productivity.

The real prevalence of AF could be underrepresented due to the fact that in up to 25 % of cases, AF occurs in the absence of symptoms, potentially underestimating the real prevalence of the disease. Monitoring techniques to detect asymptomatic, or subclinical AF, also have an impact on prevalence. AF is associated with significant morbidity. As the population age increases, so does the prevalence. Gender also had an impact on prevalence, with AF occurring more frequently in males than females, but despite a greater prevalence in men, women represent the bulk of patients with AF due to their longer survival. The impact of race is less clear.

The Pathogenesis of AF: Notwithstanding the underlying risk factors, electrophysiological changes of atrial myocardium are likely to play a role. Sustained AF seems to require the development of multiple wavelets, rather than the single wavefront seen in atrial flutter. As AF becomes established, the refractory period of the atrial muscle shortens; this electrophysiological change predisposes to further AF. In some cases, AF results from another supraventricular tachycardia.

Risk Factors: AF has been associated with cardiovascular disease, in particular with hypertension, coronary artery disease, cardiomyopathy, and valvular disease; it can also occur after cardiac surgery and in the presence of myocarditis or pericarditis. Venous thromboembolic disease, chronic obstructive pulmonary disease, obesity, diabetes, and renal disease have also been described as risk factors. Certain medications can cause or contribute to AF development. However, the absence of an accepted biologic mechanism and the susceptibility of case-control studies to unmeasured confounders make us cautious about the strength of this association.

Classification and Progression: AF has been classified as paroxysmal, persistent, permanent, or lone. Lone atrial fibrillation refers to the presence of AF with no underlying structural heart disease; it can be present in as much as 45 % of patients with paroxysmal AF.

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  1. Pediatric Emergency Medicine, Baylor College of Medicine, Houston, TX, USA

    Karina M. Soto-Ruiz MD

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  1. Karina M. Soto-Ruiz MD
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  1. Baylor College of Medicine, Department of Emergency Medicine Baylor College of Medicine, HOUSTON, Texas, USA

    W. Frank Peacock

  2. Department of Emergency Medicine, Beaumont Health System, William Beaumont Hospital, William Beaumont School of Medicine, Oakland University, Royal Oak, Michigan, USA

    Carol L. Clark

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Soto-Ruiz, K.M. (2016). Atrial Fibrillation: Epidemiology and Demographics. In: Peacock, W., Clark, C. (eds) Short Stay Management of Atrial Fibrillation. Contemporary Cardiology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-31386-3_1

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