The Global Burden of Atrial Fibrillation and Stroke::A Systematic Review of the Clinical Epidemiology of Atrial Fibrillation in Asia

Background: Our previous review showed great variability on the incidence and prevalence of atrial fibrillation (AF) in non-Western cohorts, especially from Asian countries; in recent years, epidemiology studies on AF have been increasingly reported.Methods: We therefore conducted an updated systematic review, to present the current knowledge base of AF epidemiology in Asian countries since our prior review. We also explored AF incidence and the risk of stroke in AF using meta-analysis, with I2 testing the heterogeneity. Third, ‘real world’ antithrombotic drug use for ischemic stroke (IS) prevention associated with AF was studied.Results: 58 papers from 8 countries in Asia were finally included in our analysis. The summary annual incidence of AF was 5.38 (95% CI: 4.53-6.24, I2=99.5%, N=10) per 1000 person-years and the IS annual risk in AF was 3.0% (1.60%-4.95%, I2=99.8%, N=8) when meta-analysis was performed on hospital- and community-based studies. Hospital- and community- based AF prevalence ranged from 0.37% to 3.56% and 2.8% to 15.8%, respectively. IS prevalence in AF ranged 1.9-6.0% and 0.36-28.3% in community and hospital studies, respectively. Warfarin use in Chinese is relatively low (1.0-4.1%) when compared with Japanese (49.1-70.0%) in community-based studies. The rate of warfarin use was <50% in hospital-based studies.Conclusions: AF incidence and prevalence has increased in recent years, though great variability still exists in Asian countries. Variability in annual IS risk in AF patients was apparent between hospital- and community-based studies. However, the rate of warfarin use was less than 50% in hospital studies from Asian countries