From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts & Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center (J.K., E.J.B.), Boston University School of Medicine, MA.
Department of General and Interventional Cardiology, University Heart & Vascular Center Hamburg Eppendorf, Hamburg, Germany (C.B., R.B.S.).
Circ Res. 2020 Jun 19;127(1):4-20. doi: 10.1161/CIRCRESAHA.120.316340. Epub 2020 Jun 18.
Accompanying the aging of populations worldwide, and increased survival with chronic diseases, the incidence and prevalence of atrial fibrillation (AF) are rising, justifying the term global epidemic. This multifactorial arrhythmia is intertwined with common concomitant cardiovascular diseases, which share classical cardiovascular risk factors. Targeted prevention programs are largely missing. Prevention needs to start at an early age with primordial interventions at the population level. The public health dimension of AF motivates research in modifiable AF risk factors and improved precision in AF prediction and management. In this review, we summarize current knowledge in an attempt to untangle these multifaceted associations from an epidemiological perspective. We discuss disease trends, preventive opportunities offered by underlying risk factors and concomitant disorders, current developments in diagnosis and risk prediction, and prognostic implications of AF and its complications. Finally, we review current technological (eg, eHealth) and methodological (artificial intelligence) advances and their relevance for future prevention and disease management.
随着全球人口老龄化以及慢性病患者存活率的提高,心房颤动(AF)的发病率和患病率正在上升,这一现象被恰当地称为全球流行疾病。这种多因素的心律失常与常见的伴发心血管疾病交织在一起,这些疾病都具有共同的心血管危险因素。目前还缺乏有针对性的预防方案。预防工作需要从早期开始,在人群层面上采取原始干预措施。AF 的公共卫生维度促使人们对可改变的 AF 危险因素进行研究,并提高 AF 预测和管理的精确性。在这篇综述中,我们总结了目前的知识,试图从流行病学的角度梳理这些多方面的关联。我们讨论了疾病趋势、潜在风险因素和伴发疾病提供的预防机会、目前在诊断和风险预测方面的进展,以及 AF 及其并发症的预后意义。最后,我们回顾了当前的技术(例如,电子健康)和方法学(人工智能)的进步,以及它们对未来预防和疾病管理的相关性。