Aims: To understand the changing trends in Atrial Fibrillation (AF) incidence and mortality across
Europe from 1990 to 2017, and how socioeconomic factors and sex differences play a role.
Methods and Results: We performed a temporal analysis of data from the 2017 Global Burden of
Disease Database for 20 countries across Europe using Joinpoint regression analysis. Age-adjusted
incidence, mortality and mortality to incidence ratios (MIRs) to approximate case fatality rate are
presented. Incidence and mortality trends were heterogenous throughout Europe, with Austria,
Denmark and Sweden experiencing peaks in incidence in the middle of the study period. Mortality
rates were higher in wealthier countries with the highest being Sweden for both men and women (8.83
and 8.88 per 100,000, respectively) in 2017. MIRs were higher in women in all countries studied,
with the disparity increasing the most over time in Germany (43.6% higher in women versus men in
1990 to 74.5% higher in women in 2017).
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.
This suggests 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