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Atrial fibrillation deaths higher in rich European countries

Tuesday January 26th 2021

The wealthiest European countries report higher atrial fibrillation death rates than the poorest – and women are more likely than men to die from the condition, according to the first study of its kind, published today.

The research, led by Professor Markus Sikkel, adjunct associate professor at the University of Victoria and clinical assistant professor at the University of British Columbia, Victoria, Canada, and Dr Becker Al-Khayatt, from Croydon University Hospitals NHS Trust, London, found that death rates in the richest countries are also increasing more rapidly than incidence rates.

The European Heart Journal publishes the study, which analysed data from the Global Burden of Disease Study on incidence and deaths from atrial fibrillation between 1990 and 2017 in 20 European countries, looking at trends over the study period and calculating the mortality-to-incidence ratio (MIR).

They found significant variation between countries, although the incidence of atrial fibrillation was consistently higher in men than in women in all countries throughout the study period.

Austria, Denmark and Sweden experienced peaks in incidence in the middle of the study period, while nations with lower gross domestic product (GDP) tended to record less variability with a steady decline in incidence over the years.

Sweden was found to have the highest death rates for both men and women at nine per 100,000 of the population in 2017, with a 6% increase per year in male death rates between 2001 and 2006. Germany also had a rapid and sustained increase in death rates throughout the 2000s, particularly in women, which rose by 4% every year to seven per 100,000 in 2017.

Although MIR ratios stayed about the same for many countries over the study period, increases were recorded in men and women in Sweden, Germany and Denmark, but were consistently higher for women.

The differences varied from 5.4% higher among women than men in Bulgaria in 2017, to 74.5% higher among women in Germany. Austria saw MIR decrease from 45.7% higher in women than men in 1990 to 19% higher in 2017.

Prof Sikkel said: “The ratio of deaths to cases of atrial fibrillation in Europe has not improved over time and, in many European countries, it is actually increasing despite apparent advances in treatment and care. We think this could be due to differences in lifestyles in wealthier western European countries, where risk factors such as obesity, alcohol consumption and sedentary behaviour are more prevalent than in less wealthy, eastern European countries.”

He said another important factor is that patients in wealthier nations are likely to survive other illnesses such as ischaemic heart disease and cancer, and then die from diseases, such as heart failure related to atrial fibrillation, which are more difficult to treat successfully.

Of the disparity between men and women, Dr Al-Khayatt said: “We feel there are multiple factors behind this disparity, with healthcare inequality between men and women, as well as intrinsic biological differences being plausible explanations. There is some evidence that women are diagnosed later and treated less aggressively than men.”

Al-Khayatt BM, Salciccioli JD, Marshall DC et al. Paradoxical impact of socioeconomic factors on outcome of atrial fibrillation in Europe: trends in incidence and mortality from atrial fibrillation. European Heart Journal 26 January 2021; doi:10.1093/eurheartj/ehaa1077


Tags: Europe | Heart Health | North America | UK News

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