Curious Variation in Atrial Fib Incidence, Mortality Across Europe

[EngMac]

Website:

medscape.com/viewarticle/94...

Below are a couple of statements from this website that are interesting. It seems there is a way to go to find out what causes AF since the present treatments may not be hitting the mark quite as accurately as was hoped.

"Mortality related to AF rose faster than AF incidence in countries with the highest gross domestic products (GDP), especially Sweden, Denmark, and Germany, the group reports. Despite those nations' relative affluence, notes the report, their AF incidence and mortality significantly exceeded countries with the lowest GDPs, including a number of Eastern European countries and Baltic states."

"Mortality attributable to AF per case," it contends, "has not improved over time and in many nations is actually increasing, despite apparent advances in AF care."

"That's surprising, Al-Khayatt said. "There's almost a failure to improve the situation even with all the various additions to our treatment arsenal," including better understanding of rhythm control and rate control therapies, the advent of catheter ablation, strides in oral anticoagulation, and improved services for following patients clinically."

[Hidden]

Here’s the paper referenced in the article linked by EngMac above

academic.oup.com/eurheartj/...

“Conclusion

AF incidence and mortality across Europe did not show a general trend, but unique patterns for some nations were observed. Higher mortality rates were observed in wealthier countries, potentially secondary to a survivor effect where patients survive long enough to suffer from AF and its complications. Outcomes for women with AF were worse than men, represented by higher MIRs [mortality to incidence ratios]. This suggests that there is widespread healthcare inequality between the sexes across Europe, or that there are biological differences between them in terms of their risk of adverse outcomes from AF.”

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These are disturbing findings which need exploring further.

[Karendeena in reply to Hidden]

I am really curious here, I understand that any disease can lead to death....but....my EP told me that afib is not life threatening but a 5 fold increase in stroke. Are we saying that it's strokes etc that are giving the mortality rates?

[Hidden in reply to Karendeena]

I would think stroke, heart failure and multi infarct dementia. The study linked below involved a Korean cohort.

ncbi.nlm.nih.gov/pmc/articl...

[Aus19]

Very interesting, thank you for posting this.

[MarkS]

Could this simply be down to the fact that richer countries in Europe spend a lot more on identifying AF, whereas AF is likely to go undetected in poorer countries? Also deaths due to AF would simply be put down to a stroke in poorer countries.

[CDreamer in reply to MarkS]

It could be, so many factors.

[Hidden in reply to MarkS]

Good point, but the gender differences must have another explanation

[CDreamer]

Thank you for posting - very interesting. Countries in Europe vary widely in much more than just GDP. Having more does not mean better anything. There are so many variables - climate, food/drink habits, demographics and of course medical screening. A lot there to provide further and deeper studies for more meaningful understanding as to what makes the difference.

I am not in the least surprised by the findings of sex inequalities in medical attention for AF. I posted several times a few years ago about the biological and pathological differences in AF between the sexes but how women tend to be under represented in studies and trials, less likely to seek medical help, less likely to push for a treatment resolution and more likely to be dismissed or labelled ‘anxious’ through conscious or unconscious gender bias.

healthunlocked.com/afassoci...

[Barny12]

Perhaps not unrelated to the above mentioned study....

Very Low Prevalence and Incidence of Atrial Fibrillation among Bolivian Forager-Farmers

"To assess the extent to which lifestyle factors influence AF risk, we evaluate AF prevalence and incidence in the Tsimane and Moseten, two subsistence-based populations of lowland Bolivia with active lifestyles. The Tsimane are an indigenous population of approximately 17,000 who fish, hunt, farm with hand tools, and forage for their food; they have minimal access to electricity, clean water, and public sanitation.

Tsimane and Moseten show the lowest levels of atrial fibrillation ever reported, 1/20 to ~1/6 of rates in high-income countries. These findings provide additional evidence that a subsistence lifestyle with high levels of physical activity, and a diet low in processed carbohydrates and fat is cardioprotective, despite frequent infection-induced inflammation. Findings suggest that atrial fibrillation is a modifiable lifestyle disease rather than an inevitable feature of cardiovascular aging."

ncbi.nlm.nih.gov/pmc/articl...

[Ianc2 in reply to Barny12]

So an active lifestyyle and a diet low in sugar and fat, not sugar or fat,. Were there any differences between men and women?

[Barny12]

Of the almost 2,000 people studied (50/50 male, female, ages 40 - 94) between 2005 & 2019 only 2 males had AF at the outset, and only 1 female developed AF over that time period. Absolutely amazing.

[cuore in reply to Barny12]

I only glanced at the study rather than reading it thoroughly. But, there is one point that bothered me. How much of a genetic component was there to this study? Some people do carry the genes that predispose them to AF despite how great their lifestyles are.

[JoWilmer65]

The one thing it seems that is missing is that most of them do not look for the underlying issues. Such as low magnesium or hiatal hernia. Often times these go undiagnosed.