Atrial fibrillation prevalence doubles in 10 years

The recent increase in the prevalence and burden of atrial fibrillation in Korea has highlighted the importance of preventive management through early diagnosis, leading to calls for the introduction of an electrocardiogram test that can detect atrial fibrillation at an early stage as part of the national health examination.

The Korean Heart Rhythm Society (KHRS) held a news conference last Friday at the 17th Annual International Conference of the Korean Heart Rhythm Society (KHRS 2025) to announce the current status of atrial fibrillation in Korea and future treatment strategies.

The society unveiled the “2024 Atrial Fibrillation Fact Sheet,” which analyzed data from the National Health Insurance Service over the 10 years from 2013 to 2022 and emphasized that the prevalence of atrial fibrillation in Korea has more than doubled, with a particularly high prevalence in the elderly population.

Prevalence doubles in 10 years, with a significant increase in older adults

“The prevalence of atrial fibrillation in Korea has doubled from 1.1 percent in 2013 to 2.2 percent in 2022, with a prevalence of 13 percent in older adults aged 80 years and more and 5.7 percent in those 60 and older,” said Dr. Choi Eue-keun, an academic director at KHRS and a professor at the Department of Internal Medicine at Seoul National University College of Medicine who presented the study.

During the same period, the incidence of atrial fibrillation increased by 1.5 times, with about 115,000 newly diagnosed atrial fibrillation cases in 2022, representing an incidence rate of 275 per 100,000 population.

Notably, the prevalence among people 60 and older increased 2.3 times in 10 years, suggesting that atrial fibrillation is gradually emerging as a major cardiovascular disease as we enter an aging society.

By region, North Jeolla Province had the highest prevalence rate of 3.48 percent, while Sejong City had the lowest prevalence rate of 1.55 percent.

Increasing comorbidities with aging population, making anticoagulant treatment more important

As of 2022, the average age of atrial fibrillation patients was 70.3 years old, and the prevalence of chronic diseases, such as hypertension, diabetes, and heart failure, was also high.

The CHA2DS2-VASc score, which assesses stroke risk, averaged 3.6. Eighty-three percent of patients with a score of 2 or higher needed stroke prevention, indicating that anticoagulation is indicated for most patients.

However, regional disparities in anticoagulant treatment remain a concern. In 2022, the national average prescription rate for non-vitamin K antagonist oral anticoagulants (NOACs) was 72.1 percent. Still, it varied by up to 17.2 percent between regions, including Jeju (82.1 percent), Seoul (80.5 percent), and North Jeolla (64.9 percent).

Medication adherence was also found to be a significant factor in treatment outcomes. Adherence to anticoagulants was 79.6 percent within the first year of treatment but dropped to 65 percent after one year. Patients with low adherence had a 38 percent higher risk of stroke compared to those with high adherence. That raises the need for regular patient education and follow-up.

Rhythm control treatment remains low, needing to expand electro-conversion ablation

Prescription rates for antiarrhythmic drugs, a key part of the rhythm control strategy in atrial fibrillation treatment, were 16.4 percent in 2022, up from 12 percent a decade earlier but still low. By region, Seoul, Gyeonggi Province, Daejeon, Sejong, and Daegu had relatively high prescription rates, indicating regional disparities in access to rhythm control therapy.

The rate of electrode ablation, a more radical treatment, was 0.71 percent in 2022, doubling from 10 years ago (0.35 percent) but still lower than that of major overseas countries. As of 2022, about 7,000 people in Korea have undergone radiofrequency ablation, and the procedure has been spreading rapidly, especially since the introduction of cooling balloon ablation in 2018.

Need raised for atrial fibrillation screening in national health checkups

"Atrial fibrillation can cause various complications, including stroke, heart failure, and cognitive decline, so early detection and aggressive treatment strategies are essential," Professor Choi said. "Health policy approaches are needed to increase early diagnosis rates by including atrial fibrillation screening (electrocardiogram) as part of the national health checkup, and to address regional disparities and strengthen rhythm control treatment strategies."

The KHRS emphasized that atrial fibrillation should be recognized as a major disease that threatens the cerebrovascular health of not just older adults but the entire population.

Despite its significant public health burden, with a prevalence of 13 percent in people aged 80 and older and 20.4 percent of all cerebral infarctions involving atrial fibrillation, an electrocardiogram test to diagnose atrial fibrillation is not currently included in the national health checkup.

The KHRS stressed that early diagnosis through electrocardiograms could substantially affect stroke prevention and health insurance financial efficiency, and proposed the introduction of the screening item.