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A new study looks at the most common complications of AFib. Getty Images
  • Lifetime risk of AFib has increased with 1 in 3 people at risk for the condition at some point during their lives.
  • The CDC estimates that 12.1 million U.S. adults will have atrial fibrillation by 2030.
  • A new study finds that the most common complication related to AFib is heart failure.

The risk of atrial fibrillation, the most common type of heart arrhythmia, has increased with one in three people expected to develop the disease in their lifetime. Now a new study finds that the most frequent complication of this disease is heart failure rather than stroke.

With these increasing numbers more strategies are needed to prevent either heart failure or stroke in people with atrial fibrillation, according to the study authors.

The study was published inThe BMJ, on April 17 and examined 3.5 million people in Denmark from 2000 to 2022 who had no history of atrial fibrillation at age 45 or older.

Researchers found 362,721 people with a new diagnosis of atrial fibrillation, almost evenly split between men (54%) and women (46%), and followed them until heart attack, heart failure, or stroke.

From 2000 to 2010, the lifetime risk of atrial fibrillation was 24%; from 2011 to 2022, that risk increased to 31%, with men and people who had a history of stroke, heart attack, heart failure, diabetes, or chronic kidney disease seeing a larger increase.

And among people found to have atrial fibrillation, the lifetime risk of heart failure was 41% — twice the lifetime risk of stroke (21%) and four times that of heart attack.

The Centers for Disease Control and Prevention (CDC) estimates that 12.1 million U.S. adults will have atrial fibrillation by 2030.

Nicklas Vinter, MD, PhD, Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University in Denmark, is one of the study’s authors and told Healthlinethat the study’s findings underline the need for testing new treatments and medications that can help minimize heart failure and stroke risks in people with atrial fibrillation.

“Heart failure was the major complication after atrial fibrillation in our study, but the international guidelines for the management of atrial fibrillation mainly focus on stroke prevention. The high lifetime risk of heart failure encourages greater attention to prevent heart failure after atrial fibrillation,” Vinter said.

There are four chambers in the heart — two atria and two ventricles — and atrial fibrillation occurs when those chambers don’t function properly due to abnormal electrical activity, which causes the atria and ventricles to contract at different speeds.

Advanced age, high blood pressure, hyperthyroidism, diabetes, binge drinking, and a history of underlying heart disease are all factors that can contribute to the development of atrial fibrillation, Paul Drury, MD, board certified cardiologist and associate medical director of electrophysiology at MemorialCare Saddleback Medical Center in Laguna Hills, CA, who was not involved in the study, told Healthline.

“The exact cause of atrial fibrillation is unknown; however, we know that there are multiple risk factors for developing atrial fibrillation. Non-modifiable risks include age and gender. Simply, being male and getting old puts you at risk for AFib,” Drury said. “Risk factors that are modifiable include obesity, hypertension, diabetes, sleep apnea, alcohol intake and congestive heart failure. By treating these conditions, we can often lower the lifetime risk of developing atrial fibrillation.”

Drury also pointed out that with certain conditions like hyperthyroidism or mitral valve disease “treatment of the underlying condition can resolve the AFib.”

“People are generally living longer, and we know age is a risk factor. Also, obesity, [hypertension] and diabetes are more prevalent which also increases risk,” Drury said.

Additionally, certain conditions such as obesity and diabetes that are linked to AFib are becoming more common.

“Another reason is increased detection,” Drury said. “The increased usage of ‘smart’ watches and other home health monitoring devices have detected a number of asymptomatic or minimally symptomatic cases of AFib that would have not otherwise been detected.”

Nikhil Warrier, MD, board-certified cardiac electrophysiologist and medical director of electrophysiology at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, who was not involved in the study, told Healthline that the United States has the highest prevalence of atrial fibrillation globally.

Those with European ancestry have the highest risk of developing it, he said, but African Americans are more likely to develop serious complications from it.

“The prevalence of [AFib] is increasing as a function of our population aging as age remains an independent risk factor for the development of [AFib.] Emerging studies also point to the fact that social determinants of health are drivers of cardiovascular disease,” Warrier said. “Specifically, adverse social determinants of health have been consistently associated with incident [AFib], [AFib treatment, and outcomes. Diet also plays a critical role in mitigating obesity which is a risk factor for [AFib], as access to healthy food resources can directly encourage an active lifestyle and a healthier diet.”

Both Drury and Warrier said treatment for atrial fibrillation is a lifelong process and often requires a combo of approaches.

“This includes first and foremost, managing stroke risk. This is done with medications to thin the blood, or a small device implanted in the heart to prevent blood clots,” Drury said. “Treatment is also needed to slow or regulate the heart rate in [AFib.] This can be done with either medications, an invasive procedure called an ablation, or a combination of the two. In some cases, a pacemaker can also be used.”

Additionally, lifestyle modifications to diet, sleep, exercise, and alcohol or tobacco intake are important to help manage any development of or complications from atrial fibrillation.

“Based on observational studies, the Mediterranean diet along with abstinence from smoking or alcohol intake have been shown to reduce [cardiovascular] risk in patients with [AFib]. This goes to the heart of preventing or mitigating [cardiovascular] risk,” Warrier said. “Once patients develop [AFib] and are symptomatic, medical intervention or oftentimes procedural interventions are needed to reduce burden of [AFib] and for maintenance of normal rhythm.”

The risk of developing atrial fibrillation, a common form of heart arrhythmia, rose from one in four to nearly one in three over the last decade, a Danish study found.

For those who receive a diagnosis of atrial fibrillation, the most common complication is heart failure, followed by stroke.

As people are living longer and more methods for detecting the condition are developed, it is expected that these numbers will continue on pace to rise.

Medication, diet changes, abstaining from alcohol or smoking, and other lifestyle modifications can help mitigate the effects of atrial fibrillation.