Temporal trends of atrial fibrillation and atrial flutter burden across the BRICS: An observational study analysis for the GBD 2021

Atrial fibrillation (AF) and atrial flutter (AFL) are major and rising causes of cardiovascular morbidity, but comparable long-term evidence across Brazil, Russia, India, China, South Africa (BRICS) is limited. We conducted a population level, retrospective ecological time-trend analysis using aggregated Global Burden of Disease 2021 estimates (1992-2021). We analyzed incident cases and age-standardized incidence rates (ASIRs). Age-period-cohort models quantified age, period, and cohort effects; decomposition assessed drivers of case growth; and autoregressive integrated moving average projected ASIRs for 2022 to 2036. Incident cases increased in all BRICS countries, with the highest 2021 counts in China (9,16,180) and India (5,70,120). ASIR trends differed: Brazil declined to 2019 with a recent uptick; China was relatively stable (44.9 per 1,00,000 in 2021); Russia peaked in the early 2010s then declined; India rose slightly; and South Africa declined modestly. Population growth was a major driver (India 74.71%; China 55.69%; South Africa 96.96%). By 2036, ASIRs are projected to remain high in Brazil (67.63), increase in Russia (57.22), and decline then stabilize in China (42.47); India will slightly decrease (50.07) and South Africa will remain stable (48.66). The findings highlight demographic forces as key determinants of AF/AFL burden and imply the need for tailored screening, prevention, and surveillance to guide allocation of cardiovascular care resources across BRICS.