{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T15:49:45Z","timestamp":1782920985498,"version":"3.54.5"},"reference-count":53,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early\u2010onset atrial fibrillation\/flutter (AF\/AFL), defined as AF\/AFL onset before age 45 years, can lead to adverse outcomes including heart failure (HF). The sex\u2010specific patterns of early\u2010onset AF\/AFL and associated HF remain poorly understood, particularly in comparison with late\u2010onset AF\/AFL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using data from Global Burden of Disease (GBD) 2021, we report the age\u2010standardized rates (ASRs) per 100,000 population and changes from 1990 to 2021 based on sexes, regions and 204 countries. The contributions of risk factors, decomposition methodology, slope index of inequality and Bayesian age\u2010period\u2010cohort models were utilized to assess epidemiological trends, sex disparities, and projected burdens to 2050. All the analyses were performed in both early\u2010onset and late\u2010onset AF\/AFL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Globally, the total number of early\u2010onset AF\/AFL incident cases was 204 thousand in 2021, accounting for 4.5% of all cases. The male\u2010to\u2010female ratio in global prevalence ASR was 1.62, which suggested greater sex disparities than late\u2010onset AF\/AFL. Sex\u2010specific risk factors included smoking and high alcohol use in males and high BMI in females. The global prevalence ASR of associated HF showed a sustained increase through 2050, with a female predominance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The epidemiological patterns in early\u2010onset AF\/AFL exhibited significant sex\u2010specific variations and differed from those observed in late\u2010onset AF\/AFL. Future efforts should prioritize early detection, risk stratification, and tailored interventions to curb complications, particularly HF progression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70341","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T15:21:02Z","timestamp":1782919262000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sex Differences in the Burden of Atrial Fibrillation\/Flutter and Associated Heart Failure Stratified by Age at Onset"],"prefix":"10.1111","author":[{"given":"Zijie","family":"Ding","sequence":"first","affiliation":[{"name":"Tianjin Key Laboratory of Ionic\u2010Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology the Second Hospital of Tianjin Medical University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Tian","sequence":"additional","affiliation":[{"name":"Tianjin Key Laboratory of Ionic\u2010Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology the Second Hospital of Tianjin Medical University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinhua","family":"Zhao","sequence":"additional","affiliation":[{"name":"Tianjin Key Laboratory of Ionic\u2010Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology the Second Hospital of Tianjin Medical University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y. H.","family":"Lip","sequence":"additional","affiliation":[{"name":"Tianjin Key Laboratory of Ionic\u2010Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology the Second Hospital of Tianjin Medical University  Tianjin China"},{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart &amp; Chest Hospital  Liverpool UK"},{"name":"Department of Clinical Medicine Aalborg University  Aalborg Denmark"},{"name":"Department of Cardiology, Lipidology and Internal Medicine with Intensive Coronary Care Unit Medical University of Bialystok  Bialystok Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Liu","sequence":"additional","affiliation":[{"name":"Tianjin Key Laboratory of Ionic\u2010Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology the Second Hospital of Tianjin Medical University  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.lanepe.2023.100786","article-title":"Atrial Fibrillation: Epidemiology, Screening and Digital Health","volume":"37","author":"Linz D.","year":"2024","journal-title":"Lancet Reg Health Europe"},{"issue":"4","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1093\/ehjqcco\/qcad055","article-title":"Estimating the Impact of Implementing an Integrated Care Management Approach with Atrial Fibrillation Better Care (ABC) Pathway for Patients with Atrial Fibrillation in England from 2020 to 2040","volume":"10","author":"Camacho E. 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