Prevalence, Management, and Comorbidities of Adults With Atrial Fibrillation in the United States, 2019 to 2023

Background: Due to evolving risk factor profiles and an aging population, atrial fibrillation poses a significant public health challenge in the United States. Therefore, a contemporary and nationally representative epidemiological study is necessary to reassess atrial fibrillation's impact on the health care system.

Objectives: The purpose of the study was to provide the most current and detailed assessment of atrial fibrillation's prevalence and management in the United States.

Methods: This retrospective cohort study was performed using data from Epic's Cosmos platform between January 1, 2019, and December 31, 2023. This is a multicenter, population-based study encompassing data from over 259 million patient records. The study cohort, 4,834,977 patients with atrial fibrillation, were identified from an initial cohort of 124,247,691 residents of the United States aged 18 years and older.

Results: This study identified 4,834,977 patients with nontransient atrial fibrillation, with a mean age of 76 years; 55.43% of the patients were male, and 83.05% were non-Hispanic White. The overall prevalence of atrial fibrillation was 3.89%, where 0.26% of adults under 50 and 24.58% of those 90 and older had the condition. Geographically, rural areas reported a higher prevalence (5.29%) than urban areas (3.66%), with the Midwest, South, and Northeast experiencing higher rates compared to the Mountain and Pacific states. Roughly 30% of individuals with atrial fibrillation did not receive anticoagulant medication.

Conclusions: The findings of this geographically diverse and nationally representative investigation align with recent prevalence studies, highlighting the increased burden of atrial fibrillation on the United States health care system.