Atrial Fibrillation, the most common type of cardiac arrhythmia is on the rise across the Asia-Pacific region 

• The prevalence of AFib has increased more than two-fold in the last two decades and it is predicted to rise by over 60% by the year 2050; an estimated 72 million people in the Asia-Pacific region will have AFib by 2050.

• About 30% of the patients suffer from AFib in a silent or asymptomatic form. As a result, it is often only diagnosed after a clinical consequence such as stroke or heart failure.

• People with AFib have a five-fold increase in their risk of stroke and heart failure, emphasising the need to identify patients with AFib early to better manage the condition. 

• There is a major lack of awareness of AFib and its consequences amongst the public, frontline health care professionals, and policymakers. 

“Atrial Fibrillation – Improving care pathways to meet the rising burden across the Asia-Pacific region” is an Economist Impact report, sponsored by Johnson & Johnson MedTech. This report provides an independent analysis of AFib’s growing burden in the Asia-Pacific region. The report evaluates the state of AFib care in five countries in the region (China, India, Japan, South Korea and Australia), discusses the gaps and challenges in patient care, and identifies opportunities for healthcare stakeholders to improve health outcomes for AFib patients and mitigate the impact on healthcare systems.

AFib is the most common type of cardiac arrhythmia (abnormal heart rhythm) that can negatively affect quality of life, and is a significant risk factor for ischaemic stroke, heart failure, and cognitive decline. It is a progressive disease, with one-quarter of patients with paroxysmal, or occasional AFib developing persistent AFib within 5 years. As AFib progresses, so do the risks and complications for downstream cardiovascular events.

Across the Asia Pacific, the prevalence of AFib has increased in recent decades, with AFib-related hospitalisations on the rise. By 2050, it is estimated that 49 million men and 23 million women in the region will carry a diagnosis of AFib. Ageing population; a rise in the incidence of risk factors such as obesity, hypertension, metabolic syndrome and diabetes; and enhanced detection are some of the factors contributing to the rise of AFib in Asia Pacific. 

Key insights from the report:

• Stakeholders from the five countries, focused in this report, highlighted a lack of awareness of AFib and its consequences as one of the most significant challenges for the condition. The lack of awareness manifests in different ways and among different stakeholders. For example, the general public are often unaware of the signs and symptoms of AFib. Even when diagnosed, patients frequently decline therapy or have poor adherence to treatment often due to a lack of awareness or poor risk perception. Developing and supporting patient advocacy organisations may increase patient awareness of AFib, its complications and the need for appropriate treatment. 

• Experts interviewed also reported that there is a dearth of knowledge about the burden of AFib among the medical fraternity outside of heart specialists, particularly with regards to the efficacy of anticoagulant therapies, as well as the appropriate referral pathway for patients with AFib. Interviewees also reported that awareness of treatment options, such as catheter ablation, is low among primary care doctors.

• AFib-related hospitalisations are on the rise across the region. These increases are indicative of the pitfalls in AFib care. These include a lack of early intervention, suboptimal treatment as a result of inconsistent or variation in treatment strategies, poor disease management, and unsuccessful primary prevention efforts.

• There is no universal consensus on the optimal screening mechanism for AFib, as evidenced by the diverse international recommendations on AFib screening. There is no standard protocol for AFib screening in China, India or Japan. Even in places where they do exist, such as Australia and South Korea, where single-lead ECG for screening for people aged ≥65 years is recommended, they are not implemented consistently in clinical practice. With the Asia Pacific Heart Rhythm Society’s recent publication of a three-tiered AFib screening recommendation structure, which takes into account different country characteristics, there is now a better framework for developing screening protocols in individual countries.

• The application of digital health technologies is growing across a vast range of chronic NCDs and has great potential to enhance AFib screening. Large-scale studies in China and elsewhere have been using consumer smartwatches to screen people for AFib. Prof Guo, one of the experts interviewed as part of this research programme, led a study in China with 180,000 adults. Her team noted an abnormal heart rhythm in 0.23% of participants, and 87% of these were subsequently confirmed to have AFib – illustrating wearables' impressive ability to successfully identify people with AFib. While the experts interviewed were enthusiastic about the potential of digital health technologies for AFib, they also highlighted that referral pathways and medico-legal considerations with the use of wearables for screening need to be clearly delineated.

Each of the five countries that were studied have work to do to better address the ‘silent’ public health threat posed by AFib. The first step to addressing a problem is acknowledging it—and the lack of awareness of AFib among multiple stakeholders is an important focus for action. Beyond traditional information campaigns, employing social media and technological advancements can significantly facilitate the generation of awareness among the public, primary care sector, and policymakers. Educating and integrating the primary care sector and nursing teams into AFib management and identifying appropriate patients to refer for minimally invasive and/or surgical interventions, would greatly improve care outcomes. This can be achieved through better dissemination of tailored guidelines, continuing education programmes, and access to electronic decision-making tools for management.

Gerard Dunleavy, manager at Economist Impact and editor of the report, says: 

“Often described as a silent but deadly condition, its growing prevalence demands greater attention. The chronic nature of AFib, the need for lifetime follow-up, the volume of hospitalisations, and long-term treatments associated with its critical consequences result in a significant societal burden. Fortunately, timely diagnosis and treatment can mitigate the consequences of AFib. Generating awareness and optimising care pathways are key to achieving this outcome across the region.”   

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