on August 16, 2004
Circulation. 2004
Published online before print August 16, 2004, doi: 10.1161/01.CIR.0000140263.20897.42
Published online before print August 16, 2004, doi: 10.1161/01.CIR.0000140263.20897.42
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Submitted on March 16, 2004
From the Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill (D.M.L.-J.); the National Heart, Lung, and Blood Institute’s Framingham Heart Study, National Institutes of Health, Framingham, Mass (all authors); the Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (T.J.W.); the Department of Epidemiology and Preventive Medicine (M.G.L., D.L., R.B.D., R.S.V., E.J.B.), Cardiology Department (R.S.V., E.J.B.), and Department of Neurology (P.A.W.), Boston University School of Medicine, Boston, Mass; and the Department of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, Mass (E.P.L., R.B.D., J.M.M., A.B.). * To whom correspondence should be addressed. E-mail: dlj{at}northwestern.edu.
Background--Atrial fibrillation (AF) is the most common cardiac dysrhythmia and a source of considerable morbidity and mortality, but lifetime risk for AF has not been estimated. Methods and Results--We included all participants in the Framingham Heart Study who were free of AF at index ages of 40 years and older. We estimated lifetime risks for AF (including atrial flutter) to age 95 years, with death free of AF as a competing event. We followed 3999 men and 4726 women from 1968 to 1999 (176 166 person-years); 936 participants had development of AF and 2621 died without prior AF. At age 40 years, lifetime risks for AF were 26.0% (95% CI, 24.0% to 27.0%) for men and 23.0% (21.0% to 24.0%) for women. Lifetime risks did not change substantially with increasing index age despite decreasing remaining years of life because AF incidence rose rapidly with advancing age. At age 80 years, lifetime risks for AF were 22.7% (20.1% to 24.1%) in men and 21.6% (19.3% to 22.7%) in women. In further analyses, counting only those who had development of AF without prior or concurrent congestive heart failure or myocardial infarction, lifetime risks for AF were approximately 16%. Conclusions--Lifetime risks for development of AF are 1 in 4 for men and women 40 years of age and older. Lifetime risks for AF are high (1 in 6), even in the absence of antecedent congestive heart failure or myocardial infarction. These substantial lifetime risks underscore the major public health burden posed by AF and the need for further investigation into predisposing conditions, preventive strategies, and more effective therapies.
Revised on May 12, 2004
Accepted on May 19, 2004
Lifetime Risk for Development of Atrial Fibrillation. The Framingham Heart Study
Donald M. Lloyd-Jones MD, ScM*,
Key words: atrial fibrillation • epidemiology • risk factors
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