Top 10 takeaways – the need to increase focus and awareness of atrial fibrillation

Moe Bishara

A new report from Biosense Webster sets out the scale and impact of atrial fibrillation (AF) across Europe and calls for greater awareness and understanding around the effects of AF, the need for earlier detection and diagnosis of this progressive and often debilitating condition. Moe Bishara, (Johnson & Johnson Medical Devices, Irvine, USA) now provides his top 10 takeaways from this report.

The lack of awareness of the burden of AF means that it is difficult to prioritise on the health agenda despite its increasing impact on healthcare systems. The report developed by Biosense Webster, “The burden of atrial fibrillation – understanding the impact of the new millennium epidemic across Europe,” serves as a welcome tool that clearly outlines the critical situation and provides a good starting point for renewed focus on this clinical challenge.

AF is a new millennium epidemic that affects millions of lives, mostly impacting on the middle aged and our growing elderly population. AF is the most common type of cardiac arrhythmia, affecting over 886,000 new people each year across Europe and is fast becoming one of Europe’s most significant health issues.

  1. 11 million people are currently estimated to be affected by AF across Europe and by 2030, this number is expected to have increased by 70%.
  2. AF is now almost as common as stroke and cancer across Europe,1 yet awareness about this condition is lacking.
  3. The causes of AF differ by patient. Abnormalities or damage to cardiac structure are the most common cause.2,3 The major causes of AF require better characterisation by patient group, considering the comorbidities associated with AF.
  4. AF can be silent (up to 30% of patients may experience no symptoms), which means educating people on knowing their pulse and heart rhythm is key to supporting earlier diagnosis and effective treatment.
  5. The impact of AF on patient and carers’ lives is significant and shouldn’t be underestimated. Up to 47% of patients report a reduction in quality of life.
  6. Patients are not just affected by AF itself, as many as 80% of AF patients have another condition or cardiac disease.2 AF patients have a five-fold increased risk of heart failure, a 2.4-fold increased risk of stroke and a two-fold increased risk of cardiovascular mortality.
  7. The additional 886,000 new cases of AF are projected to translate into 280,000-340,000 additional ischaemic strokes, 3.5-4 million hospitalisations for AF and 100-120 million outpatient visits.2
  8. AF is not only placing a burden on patients but an increasing critical financial burden on healthcare systems, costing up to €3,286 million annually across Europe and an estimated 2.6% of the total annual healthcare expenditure.8-12
  9. There is a lack of up-to-date research on the risks, causes and treatment outcomes relating to AF and this needs to be addressed to support political prioritisation. More recent data from robust studies are needed to understand the current epidemiology and cost burden of AF for Europe and individual countries.
  10. Knowledge of AF must extend beyond the cardiac community to improve early detection, diagnosis and management, especially as AF is typically a progressive disease with one in five progressing to persistent AF in a year.4-16

Click here to read the Burden of AF Report


  1. Global Burden of Disease Collaborative Network (2016) Global Burden of Disease Study 2016 (GBD 2016) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2017. Accessed 2018-04-20. Available from
  2. Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S (2014) Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol 6 213-220.
  3. Reinstra M, Lubitz SA, Mahida S et al. (2012) Symptoms and functional status of patients with atrial fibrillation: state of the art and future research opportunities. Circulation 125 (23): 2933-2943.
  4. Boriani G, Laroche C, Diemberger I et al. (2015) Asymptomatic atrial fibrillation: clinical correlates, management and outcomes in the EORP-AF Pilot General Registry. Am J Med 128 (5) 509-518 E502.
  5. Dorian P, Jung W, Newman D, Paquette M et al. (2000) The impairment of health-related quality of life in patients with intermittent atrial fibrillation: implications for the assessment of investigational therapy. J M Coll Cardiol 36(4): 1303-1309.
  6. Van der Berg M P, Hassink RJ, Tuinenburg AE et al. (2001) Quality of life in patients with paroxysmal atrial fibrillation and its predictors: importance of the autonomic nervous system. Eur Heart J 22 (3) 247-253.
  7. Odutayo A, Wong CX, Hsiao AJ et al. (2016) Atrial fibrillation and risks of cardiovascular disease, renal disease and death; systemic review and meta-analysis. BMJ 354 i4482.
  8. McBride D, Mattenklotz AM, Willich SN, Bruggenjurgen B. (2009) The costs of care in atrial fibrillation and the effect of treatment modalities in Germany. Value Health 12 (2): 293-301.
  9. Ball J, Carrington MJ, McMurray JJ, Stewart S. (2013) Atrial fibrillation: profile and burden of an evolving epidemic in the 21st century. Int J Cardiol 167 (5): 1807-1824.
  10. Cotte FE, Chaize G, Gaudin AF, Samson A, Vainchtock A et al. (2016) Burden of stroke and other cardiovascular complications in patients with atrial fibrillation hospitalized in France. Europace 18 (4): 501-507.
  11. Stewart S, Murphy NF, Walker A, McGuire A, McMurray JJ. (2004) Cost of an emerging epidemic: an economic analysis of atrial fibrillation in the UK. Heart 90 (3): 286-292.
  12. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators (2017) Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390 (10100): 1211-1259.
  13. Wolowacz SE, Samuel M, Brennan VK et al. (2011) The cost of illness of atrial fibrillation: a systemic review of the recent literature. Eurospace 13 (10): 1375-1385.
  14. Nieuwlaat R, Prins MH, Le Heuzey JY, Vardas PE, Aliot E et al. (2008) Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on atrial fibrillation. Eur Heart J 29 (9): 1181-1189.
  15. de Vos CB, Pisters R, Nieuwlaat R, Prins MH, Tieleman RG et al. (2010) Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis. J Am Coll Cardiol 55 (8): 725-731.
  16. Schnabel R, Pecen L, Engler D, Lucerna M, Sellal JM et al. (2018) Atrial fibrillation patterns are associated with arrhythmia progression and clinical outcomes. Heart 2018 Oct;104(19):1608-1614.


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