A FA é a arritmia cardíaca sustentada mais comum em todo o mundo.[1]Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2024 Jan 2;149(1):e1-156.
https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001193
http://www.ncbi.nlm.nih.gov/pubmed/38033089?tool=bestpractice.com
O estudo Global Burden of Disease de 2017 constatou que a prevalência da FA é de 481.5 por 100,000 pessoas-ano, afetando 19.8 milhões de homens e 17.8 milhões de mulheres em todo o mundo.[4]Wang L, Ze F, Li J, et al. Trends of global burden of atrial fibrillation/flutter from Global Burden of Disease Study 2017. Heart. 2021 Jun;107(11):881-7.
https://heart.bmj.com/content/107/11/881
http://www.ncbi.nlm.nih.gov/pubmed/33148545?tool=bestpractice.com
A prevalência global estimada foi de 50 milhões em 2020.[1]Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2024 Jan 2;149(1):e1-156.
https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001193
http://www.ncbi.nlm.nih.gov/pubmed/38033089?tool=bestpractice.com
Entretanto, é difícil determinar a real prevalência. As taxas de incidência e prevalência são mais altas em idosos e em países desenvolvidos, com a maior prevalência na América do Norte de alta renda.[4]Wang L, Ze F, Li J, et al. Trends of global burden of atrial fibrillation/flutter from Global Burden of Disease Study 2017. Heart. 2021 Jun;107(11):881-7.
https://heart.bmj.com/content/107/11/881
http://www.ncbi.nlm.nih.gov/pubmed/33148545?tool=bestpractice.com
[5]Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 study. Circulation. 2014 Feb 25;129(8):837-47.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151302
http://www.ncbi.nlm.nih.gov/pubmed/24345399?tool=bestpractice.com
Embora a incidência e a prevalência da FA ajustada à idade sejam menores em mulheres que em homens, o risco de mortalidade decorrente de FA é semelhante ou mais elevado nas mulheres que nos homens.[2]Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021 Feb 1;42(5):373-498.
https://academic.oup.com/eurheartj/article/42/5/373/5899003?login=false
Mulheres com FA podem ser mais sintomáticas, idosas e/ou ter mais comorbidades que os homens.[5]Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 study. Circulation. 2014 Feb 25;129(8):837-47.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151302
http://www.ncbi.nlm.nih.gov/pubmed/24345399?tool=bestpractice.com
No Reino Unido, a prevalência da FA na clínica geral é de cerca de 2.5% a 5.0% e, entre as internações por emergências clínicas agudas, de 3% a 6% dos pacientes têm FA.[6]Sudlow M, Thomson R, Thwaites B, et al. Prevalence of atrial fibrillation and eligibility for anticoagulants in the community. Lancet. 1998 Oct 10;352(9135):1167-71.
http://www.ncbi.nlm.nih.gov/pubmed/9777832?tool=bestpractice.com
[7]Lip GY, Golding DJ, Nazir M, et al. A survey of atrial fibrillation in general practice: the West Birmingham Atrial Fibrillation Project. Br J Gen Pract. 1997 May;47(418):285-9.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313001
http://www.ncbi.nlm.nih.gov/pubmed/9219403?tool=bestpractice.com
[8]Adderley NJ, Ryan R, Nirantharakumar K, et al. Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016. Heart. 2019 Jan;105(1):27-33.
http://www.ncbi.nlm.nih.gov/pubmed/29991504?tool=bestpractice.com
[9]Lip GY, Tean KN, Dunn FG. Treatment of atrial fibrillation in a district general hospital. Br Heart J. 1994 Jan;71(1):92-5.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC483620
http://www.ncbi.nlm.nih.gov/pubmed/8297706?tool=bestpractice.com
[10]Zarifis J, Beevers G, Lip GY. Acute admissions with atrial fibrillation in a British multiracial hospital population. Br J Clin Pract. 1997 Mar;51(2):91-6.
http://www.ncbi.nlm.nih.gov/pubmed/9158252?tool=bestpractice.com
[11]National Institute for Health and Care Excellence. Atrial fibrillation: diagnosis and management. Jun 2021 [internet publication].
https://www.nice.org.uk/guidance/ng196
Os dados epidemiológicos sobre FA inicial são limitados. Uma extrapolação do estudo de Framingham indica que a incidência de FA inicial em mulheres e homens de meia-idade (55 anos) é de 0.2% e 0.3%, respectivamente.[12]Lip GYH, Apostolakis S. Atrial fibrillation (acute onset). BMJ Clin Evid. 2014 Nov 27;2014.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4246362
http://www.ncbi.nlm.nih.gov/pubmed/25430048?tool=bestpractice.com
Nos pacientes com primeiro episódio de acidente vascular cerebral (AVC) isquêmico, existe uma alta prevalência (15% a 25%) de FA, e a incidência de FA é de cerca de 5%.[13]Marini C, De Santis F, Sacco S, et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke, results from a population-based study. Stroke. 2005 Jun;36(6):1115-9.
https://www.ahajournals.org/doi/full/10.1161/01.STR.0000166053.83476.4a?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
http://www.ncbi.nlm.nih.gov/pubmed/15879330?tool=bestpractice.com
[14]Paciaroni M, Agnelli G, Caso V, et al. Atrial fibrillation in patients with first-ever stroke: frequency, antithrombotic treatment before the event and effect on clinical outcome. J Thromb Haemost. 2005 Jun;3(6):1218-23.
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1538-7836.2005.01344.x
http://www.ncbi.nlm.nih.gov/pubmed/15892862?tool=bestpractice.com
Estudos avaliando o monitoramento prolongado por eletrocardiograma (ECG; usando um gravador desencadeado por evento por 30 dias ou um dispositivo de monitoramento cardíaco implantável) em pacientes com acidente vascular cerebral (AVC) criptogênico demonstraram que a FA é comum nesses pacientes.[15]Gladstone DJ, Spring M, Dorian P, et al. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med. 2014 Jun 26;370(26):2467-77.
http://www.nejm.org/doi/full/10.1056/NEJMoa1311376#t=article
http://www.ncbi.nlm.nih.gov/pubmed/24963566?tool=bestpractice.com
[16]Sanna T, Diener HC, Passman RS, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. 2014 Jun 26;370(26):2478-86.
http://www.nejm.org/doi/full/10.1056/NEJMoa1313600#t=article
http://www.ncbi.nlm.nih.gov/pubmed/24963567?tool=bestpractice.com
[17]Katsanos AH, Kamel H, Healey JS, et al. Stroke prevention in atrial fibrillation: looking forward. Circulation. 2020 Dec 15;142(24):2371-88.
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049768
http://www.ncbi.nlm.nih.gov/pubmed/33315494?tool=bestpractice.com
A FA inicial ocorre aproximadamente em 10% dos pacientes após um infarto agudo do miocárdio e em 20% dos pacientes com insuficiência cardíaca, e prediz, de modo independente, um prognóstico desfavorável em curto e longo prazos entre os pacientes com essas afecções.[18]Wong CK, White HD, Wilcox RG, et al. New atrial fibrillation after acute myocardial infarction independently predicts death: the GUSTO-III experience. Am Heart J. 2000 Dec;140(6):878-85.
http://www.ncbi.nlm.nih.gov/pubmed/11099991?tool=bestpractice.com
[19]Asanin M, Perunicic J, Mrdovic I, et al. Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial infarction. Eur J Heart Fail. 2005 Jun;7(4):671-6.
https://onlinelibrary.wiley.com/doi/full/10.1016/j.ejheart.2004.07.018
http://www.ncbi.nlm.nih.gov/pubmed/15921810?tool=bestpractice.com
[20]Mentz RJ, Chung MJ, Gheorghiade M, et al. Atrial fibrillation or flutter on initial electrocardiogram is associated with worse outcomes in patients admitted for worsening heart failure with reduced ejection fraction: findings from the EVEREST Trial. Am Heart J. 2012 Dec;164(6):884-92;e2.
http://www.ncbi.nlm.nih.gov/pubmed/23194489?tool=bestpractice.com
[21]Gorenek B, Halvorsen S, Kudaiberdieva G, et al. Atrial fibrillation in acute heart failure: A position statement from the Acute Cardiovascular Care Association and European Heart Rhythm Association of the European Society of Cardiology. Eur Heart J Acute Cardiovasc Care. 2020 Jun;9(4):348-57.
https://academic.oup.com/ehjacc/article/9/4/348/5950241
http://www.ncbi.nlm.nih.gov/pubmed/31976747?tool=bestpractice.com
[22]He J, Yang Y, Zhang G, et al. Clinical risk factors for new-onset atrial fibrillation in acute myocardial infarction: A systematic review and meta-analysis. Medicine (Baltimore). 2019 Jun;98(26):e15960.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6616519
http://www.ncbi.nlm.nih.gov/pubmed/31261502?tool=bestpractice.com