Clinical, economic, and quality of life impact of atrial fibrillation.

BACKGROUND Atrial fibrillation (AF) is a common, age-related arrhythmia that disproportionately affects men, adversely affects quality of life, and causes considerable morbidity and mortality. OBJECTIVES To describe trends in the prevalence and incidence of AF in the United States; discuss the etiologies and complications of AF; characterize the economic burden of AF; and predict an individual's risk for developing AF and AF-related stroke. SUMMARY The prevalence and incidence of AF in the United States are expected to increase in the coming decades because of the aging of the population; improved survival rates associated with coronary heart disease, heart failure, and hypertension; and increased rate of performance of surgical procedures. The economic burden of AF is substantial because of high rates of hospitalization and other health resource utilization. Hypertension, coronary heart disease, and systolic heart failure are the most important risk factors for AF. Ischemic stroke is the most devastating complication of AF. Risk factors for stroke in patients with AF include recent congestive heart failure, hypertension, advanced age, diabetes mellitus, and a history of stroke or transient ischemic attack. Risk scoring systems have been developed to predict an individual's risk for developing AF and the risk for stroke in a patient with AF. The estimated lifetime risk for AF in men and women aged 40 years of age or older is 1 in 4, which is higher than the risk for other diseases that are a common cause for concern among elderly patients. CONCLUSIONS The clinical and economic burden of AF in the United States is large and will continue to increase in the future. The use of scoring systems to predict the risk of AF and AF-related stroke affords clinicians the opportunity to intervene to minimize these risks and improve patient outcomes.