AFib: Why More People Under 65 Are Being Diagnosed

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Share on PinterestThe risk of AFib may be higher for people under 65 than previously believed. anadorado/Getty Images

• A new study suggests that atrial fibrillation (AFib) may be more common in people under 65 than shown by previous research.
• Younger people with AFib also had an increased risk of dying or hospitalization compared to similarly-aged people without AFib.
• Experts say it is not clear if AFib is increasing among younger people or if doctors are detecting it more often. It may be both.

Atrial fibrillation (AFib or AF), a condition involving irregular heart rhythms, is more common in people under the age of 65 than previously thought, a new study shows.

Adults in this age group also had an increased risk of dying and being hospitalized for heart attack, heart failure, or stroke, compared to similarly-aged people without AFib, researchers found.

"Common knowledge among cardiologists is that, in people under 65, AFib is extremely uncommon and not detrimental. But there really hasn't been any data to back that up," study author Aditya Bhonsale, MD, a cardiac electrophysiologist at University of Pittsburgh Medical Center's Heart and Vascular Institute, said in a release.

The study was published April 22 in the journal Circulation: Arrhythmia and Electrophysiology.

Atrial fibrillation, the most common type of arrhythmia, affected an estimated 5.2 million Americans in 2010, with this expected to grow to 12.1 million by 2030.

This condition causes the heart to beat irregularly and sometimes faster than normal, which can lead to symptoms such as feeling lightheaded, tired, or dizzy. You may also feel like your heart is fluttering, beating too quickly or hard, or skipping a beat.

Left untreated, AFib can cause heart disease or make your existing heart disease worse. It also increases the risk of complications such as heart failure and stroke.

"AFib is typically a disease of older people," said Bradley Knight, MD, medical director of electrophysiology at Northwestern Medicine Bluhm Cardiovascular Institute in Chicago, who was not involved in the study. "As people get older, they can develop abnormalities in the atrium [of their heart], which can lead to atrial fibrillation."

While the risk of AFib among older adults is well known, this condition was previously thought to be not very common among younger adults.

For example, a 2001 study found that less than 1% percent of American adults younger than 55 years old had AFib, compared to 9% of people 80 years or older. Similar results were seen in a more recent European study.

In the new study, UPMC researchers found that AFib was more common in their younger patient population than what was seen in those earlier studies.

To determine this, they reviewed medical records for over 67,000 adults who had at least two outpatient visits at a UPMC clinic between 2010 and 2019 related to a diagnosis of AFib.

Although the average age of patients with AFib was 72 years old, nearly one-quarter were under 65, with the majority of younger patients being men.

Researchers also assessed the risks of hospitalization and dying faced by younger people with AFib. Other research shows that AFib increases the risk of dying early, but many of those studies focused on older adults.

After reviewing the 10-year survival for younger patients, researchers found that men with AFib were 1.3 to 1.5 times more likely to die, compared to similarly aged men without AFib.

For younger women with AFib, the risk of dying was 1.7 to 2.4 times worse compared to younger women without this condition.

Many people in this younger age group had risk factors for cardiovascular disease, including obesity, smoking, high blood pressure, diabetes, and obstructive sleep apnea.

Over time, these conditions can lead to physical damage and electrical changes in the heart that result in AFib.

Jim Liu, MD, a cardiologist at The Ohio State University Wexner Medical Center in Columbus, who was not involved in the study, said this study highlights that AFib in younger patients is a "serious condition," especially "as AFib becomes more prevalent in younger adults and is not just isolated to elderly patients."

So is AFib really becoming more common in people under 65 years, or are doctors getting better at detecting this condition?

It might be a little bit of both.

"We are probably doing a better job at detecting AFib," Liu told Healthline. For example, "so many people now have personal wearable devices, like smartwatches and other monitors, that can detect AFib."

"However, risk factors for AFib — such as obesity, sleep apnea, diabetes and hypertension — are also increasing in younger patients."

Other risk factors for AFib include consuming large amounts of alcohol and viral infections such as COVID-19.

Many of these can be modified to reduce your risk of developing AFib.

"It's important to address the risk factors for AFib," said Liu. "This means getting conditions like [high blood pressure], sleep apnea, and diabetes under control. It also means losing weight if someone is overweight."

Even though the new study suggests that AFib may be more common in younger people than previously known, Knight said clinical guidelines don't recommend routine screening of all patients for AFib.

"[Screening] may be important in patients with risk factors, particularly older patients, and patients with heart disease or [high blood pressure]," he said, "but I don't know that we need to screen for it in very young patients [who don't have symptoms]."

However, "[AFib] is being screened for more often due to these wearable devices that are available without a prescription," he said.

Knight thinks these kinds of devices can be useful in managing patients who are already diagnosed with AFib. For example, if someone thinks they are having possible symptoms of AFib, they can use their wearable device to record their heart rhythm and send the recording to their doctor for review.

They could also record their rhythms once a week after a heart-related procedure or a change in their medications to see if their heart is staying within a normal rhythm.

"These are very valuable tools, but there is also the problem of false positives," said Knight. "A lot of young, healthy people are told they have AFib by their device," but a follow-up with a doctor may show that it was a false positive.

He recommends that anyone with heart-related symptoms such as palpitations (fast-beating, fluttering or pounding heart), chest pain, or sudden shortness of breath talk with their doctor or other medical professional.

"One of the tests might be for them to wear a long-term heart monitor that will detect any atrial fibrillation that they might have," said Knight.

Researchers examined the medical records of over 67,000 people with AFib. Nearly one-quarter of these patients were younger than 65 years old.

AFib was previously thought to affect those over 65 years old, with rates increasing with age. However, this study suggests that this condition also impacts younger people.

Many younger patients with AFib in the study had risk factors for AFib, such as obesity, high blood pressure, diabetes, and obstructive sleep apnea.