1. Atrial Fibrillation: An Escalating Cardiovascular Disease With Significant Clinical and Economic Consequences

2. Projection for Prevalence of Atrial Fibrillation: 5.6 Million by 2050
Projected number of adults with atrial fibrillation in the United States between 1995 and 2050
7.0
6.0
5.42
5.61
5.0
5.16
4.78
4.34
4.0
Adults with atrial fibrillation
in millions
3.80
3.33
3.0
2.94
2.66
2.44
2.0
2.08
2.26
1.0
Upper and lower curves represent the upper and lower scenarios based on sensitivity analyses.
Years
Go AS et al. JAMA. 2001;285:

3. Atrial Fibrillation Is Associated With Increased Mortality
With atrial fibrillation
Without atrial fibrillation
71.3
65.1*
62.4
54.5
51.0*
47.4*
47.5
38.6
Cumulative mortality over 3 years (%)
34.0
36.1*
30.2*
25.4*
Men
Women
Men
Women
Men
Women
65 to 74 years of age
75 to 84 years of age
85 to 89 years of age
* Significantly different from patients with atrial fibrillation (P<.05).
Wolf PA et al. Arch Intern Med. 1998;158:

4. Atrial Fibrillation: Major Cause of Stroke in the United States
15% of all strokes attributable to atrial fibrillation
75,000 strokes per year attributable to atrial fibrillation
3- to 5-fold increase in risk of stroke in patients with atrial fibrillation
Stroke risk persists even in asymptomatic atrial fibrillation
Go AS et al. JAMA. 2001;285: ; Go AS. Am J Geriatr Cardiol. 2005;14:56-61; Wolf PA et al. Stroke. 1991;22: ; Benjamin EJ et al. Circulation. 1998;98: ; Page RL et al. Circulation. 2003;107:

5. Prevalence per 10,000 persons
Increasing Hospitalizations in the United States When Atrial Fibrillation Is Principal Diagnosis (National Hospital Discharge Survey) 20 40 60 80
100
120
140
Prevalence per 10,000 persons
1985
1987
1989
1991
1993
1995
1997
1999
Year
Age (years)
85+
75 to 84
65 to 74
55 to 64
35 to 54
Wattigney WA et al. Circulation. 2003;108:

6. Atrial Fibrillation Adversely Affects Quality of Life (QoL)
Lower scores = poorer QoL
SF-36 score
Dorian P et al. J Am Coll Cardiol. 2000;36:

7. Atrial Fibrillation Causes Several Types of Remodeling Over Time That Have Adverse Physiologic Consequences
Electrophysiologic changes
Shortening of atrial refractory periods
Loss of normal adaptation of atrial refractoriness to heart rate
Contractile changes
Reduced atrial contractility
Structural changes
Left atrium and left atrial appendage enlargement
Decrease in cardiac output
Histologic changes
Prothrombotic changes (increased propensity for clot formation)
Atrial stasis
Increases prothrombotic factors
Hobbs WJC et al. Circulation. 2000;101: ; Sanfilippo AJ et al. Circulation. 1990;82: ; Thijssen VLJL et al. Cardiovasc Pathol. 2000;9:17-28; Van Gelder IC et al. Europace. 2006;8: ; Peters NS et al. Lancet. 2002;359:
Hobbs WJC, Fynn S, Todd DM, Wolfson P, Galloway M, Garratt CJ. Reversal of atrial electrical remodeling after cardioversion of persistent atrial fibrillation in humans. Circulation. 2000;101:
Sanfilippo AJ, Abascal VM, Sheehan M, et al. Atrial enlargement as a consequence of atrial fibrillation: a prospective echocardiographic study. Circulation. 1990;82:
Thijssen VLJL, Ausma J, Liu GS, Allessie MA, van Eys GJJM, Borgers M. Structural changes of atrial myocardium during chronic atrial fibrillation. Cardiovasc Pathol. 2000;9:17-28.

8. Atrial Fibrillation Causes Histologic Remodeling of Atria as Early as 4 Months
Myolysis
Sinus rhythm
Atrial fibrillation
Enlarged atrial cells
Severe myolysis
Glycogen accumulation
Reduction in connexin 40 expression
Connexin 40
Ausma J et al. Circulation. 1997;96: ; Van der Velden HMW et al. J Cardiovasc Electrophysiol. 1998;9:

9. Patients in sinus rhythm (%)
Patients Converted to Sinus Rhythm Within 3 Months of Onset Are More Likely to Remain in Sinus Rhythm
82%
67%
Patients in sinus rhythm (%)
36%
27%
1 month
P<.02
6 months
P<.07
The longer one waits to initiate a rhythm-control strategy, the harder it is to regain sinus rhythm
Dittrich HC et al. Am J Cardiol. 1989;63:

10. Long-term Maintenance of Sinus Rhythm Improves Functional Capacity: AFFIRM
Mean New York Heart Association functional class (NYHA-FC) score significantly better at each visit in patients in sinus rhythm
0.50
0.45
0.40
0.35
0.30
0.25
0.20
0.15
0.10
0.05
Mean NYHA-FC score
(Lower NYHA-FC score = less symptomatic)
Adjusted P<.0001
Current atrial fibrillation
No current atrial fibrillation
Initial 2 4 8 1 1⅓ 1⅔ 2⅓ 2⅔ 3 3⅓ 3⅔ 4⅓ 4⅔ 5
Months
Years
Chung MK et al. J Am Coll Cardiol. 2005;46:

11. Decreasing Atrial Fibrillation Burden Is an Important Goal
As with heart failure or angina, success in managing atrial fibrillation is defined as a decrease in:
Decreasing atrial fibrillation burden offers potential to successfully treat atrial fibrillation by:
Decreasing mortality
Decreasing hospitalizations
Increasing QoL
Frequency of episodes
Duration of episodes
Symptoms during episodes
Prystowsky EN. J Cardiovasc Electrophysiol. 2006;17(suppl 2):S7-S10; Wolf PA et al. Arch Intern Med. 1998;158:

12. Summary
Atrial fibrillation is a chronic, cardiovascular disease with increasing socioeconomic impact
Prevalence of atrial fibrillation is projected to be 5.6 million by 2050
Atrial fibrillation is associated with increased risk of mortality, risk of stroke, and compromised QoL
Hospitalizations for atrial fibrillation have increased 2- to 3-fold and are projected to continue rising
Early restoration and maintenance of sinus rhythm has an integral role in overall atrial fibrillation treatment strategy
Atrial fibrillation causes several types of remodeling over time that have adverse physiologic consequences
Atrial fibrillation causes histologic remodeling of the atria as early as 4 months
Sustaining sinus rhythm may be associated with decreased mortality
Decreasing atrial fibrillation burden offers potential to successfully treat atrial fibrillation
As with other chronic cardiovascular diseases, successful management of atrial fibrillation includes an overall reduction in frequency and duration of episodes, while reducing symptoms during episodes
A measure of success can be defined by decreased mortality, decreased hospitalizations, and increased QoL