Patterns and trends in atrial fibrillation and atrial flutter incidence rates in G20 countries (1990-2021) and predictions to 2050.

The long-term trend in atrial fibrillation (AF) and atrial flutter (AFL) incidence has rarely been reported from a global perspective. We aimed to explore the past temporal trends (1990-2021) in AF/AFL incidence in group of 20 countries and to predict future trends (2022-2050). Data on yearly AF/AFL incidence by age group and sex were extracted from the global burden of disease study 2021. Age-standardized incidence rates (ASIR) were computed from 1990 to 2021. The number of new cases and incidence rates were predicted to 2050 using the Bayesian age-period-cohort model. The ASIR for AF/AFL exhibited a slight increasing trend on a global scale from 1990 to 2021, with an average annual percent change of 0.5% (95% confidence interval: 0.5-0.5). Canada had the highest ASIR of AF/AFL (97.53/100,000) and showed a significant declining trend from 1990 to 2021, while the USA and Germany showed a clear upward trend and a "wave-like" upward trend, respectively. Notably, Italy experienced a significant increase in the ASIR of AF/AFL during the COVID-19 pandemic (2019-2021), with an annual percent change of 9.3% (95% confidence interval: 6.6-12.0). The ASIR of AF/AFL in developing countries increased more significantly than in developed countries (ASIR change percentage: 4.79% vs 0.20%). The ASIR of AF/AFL is predicted to remain stable or increase in most countries by 2050. AF/AFL remains a significant public health concern, necessitating the development of more precise strategies for prevention, control, and surveillance, particularly among specific populations and endemic countries.