If you’ve been diagnosed with atrial fibrillation, you probably have several urgent questions. “Does this mean I’m going to be very sick? What does it mean for my quality of life going forward?” And perhaps most pressingly of all, “Does this mean I should expect a much shorter lifespan?”
Today, we have greatly improved tools at our disposal for managing atrial fibrillation, or A-fib. The condition, a rapid, irregular heartbeat caused by faulty electrical impulses in the heart’s upper chambers, can be controlled through medications, procedures, and lifestyle changes. The principal danger of atrial fibrillation is increased risk of stroke, but this, too, can be addressed with anticoagulant drugs that make it less likely for blood that pools in the heart’s chambers to form clots that can lead to strokes. All of this means that we are making progress in maintaining quality of life for people with A-fib, and we’re chipping away at the life-expectancy gap as well.
Hospitalization from A-fib
A large study from Australia, published in 2024, found that people hospitalized with atrial fibrillation or atrial flutter were frequently readmitted to the hospital. Within one year of being hospitalized, 21% of them re-entered the hospital for atrial fibrillation or flutter. By five years, more than 35% of them had been re-hospitalized, and by 10 years, 41%. Those figures exclude hospitalization for reasons other than atrial fibrillation or flutter. But the study also looked at hospitalization rates for other reasons and found that in the 10 years following their initial hospitalization, 16.8% of patients were re-hospitalized with heart failure, 11% with stroke, and 7% with heart attack.
Survival rates for A-fib
In 2007, the journal Circulation published a study involving 76 people with “lone” atrial fibrillation, meaning that they did not also have heart disease or hypertension (high blood pressure). Researchers compared those people’s survival rates to those of the local population using sex- and age-matching. Surprisingly, the atrial fibrillation group did slightly better than the control group both at the 15-year and 30-year mark. At 15 years, 92% of the A-fib patients were still alive compared to only 85% of those in the control group, and at 30 years, 68% of A-fib patients had survived, compared to only 57% of the control group. This study suggests that it is not atrial fibrillation itself that kills, but rather the other conditions that so often accompany it (sometimes referred to as “the bad company it keeps”).
But “lone” A-fib is relatively rare. At least 70% of patients have known “comorbidities” (additional diseases or conditions) at the time of their diagnosis, and experts suspect that many of the remaining 30% have unrecognized comorbidities. These drive up the risk of death. A 2015 meta-analysis estimates that “factors such as smoking, lung disease, hypertension, diabetes, and obesity act to increase mortality risk by around 20% to 60% each, and the effects are additive with additional risk factors.”
So what happens when you look not at lone A-fib but at the condition as it usually occurs, alongside heart disease, hypertension, diabetes, and other diseases? A 2018 study from South Korea did just that. Examining data on more than 15,000 patients, the researchers found that over an 11-year period, people with atrial fibrillation were 3.7 times more likely to die from any cause than people without the condition. The effect was even stronger in women, who faced a 3.8-fold increased risk of death. The most common cause of mortality was cardiovascular disease (usually culminating in stroke), which accounted for 38.5% of deaths among the people with A-fib. To put that into perspective, people with A-fib were at five times the risk of death from cardiovascular disease compared to the general population.
Life expectancy
The large Australian study cited above also calculated the decrease in life expectancy associated with atrial fibrillation or flutter. It found that, on average, a person with atrial fibrillation can expect to live 2.6 years less than people without A-fib, which amounts to 16.8% of life expectancy.
That figure is less encouraging than the findings of a 2021 BMJ paper which analyzed data from the famous Framingham Heart Study. It looked at the mortality rates of people with atrial fibrillation at three different time periods. Between 1972 and 1985, the life expectancy of an A-fib patient was 2.9 years shorter than that of the general population. For the period 1986 to 2000, that gap had narrowed to 2.1 years. And for 2001 to 2015, the decrease in life expectancy had shrunk still further, to 2.0 years.
Treatment leads to hope
The trend suggested by the Framingham data is “heartening”, one might say. Likely because of greater awareness about the seriousness of atrial fibrillation alongside better treatments and procedures, the life-expectancy gap of people with A-fib is shrinking.
If you have atrial fibrillation, you can do a lot to give yourself bet3ter chances of living just as long as the next person. Your first priority should be to take the condition seriously and open a conversation with your doctor about the best strategies for treating and managing you’re A-fib. This will probably involve getting on an anticoagulant drug to reduce your stroke risk, and it may include procedures such as catheter ablation or cardioversion.
Along with medications and procedures, you’ll give yourself the best chances of living a long life if you adopt a healthy lifestyle including a good diet, an exercise routine approved by your doctor, and stress reduction. Cut back on alcohol or quit it altogether, and stop smoking. Take care of any sleep apnea. If you have diabetes along with A-fib, getting your diabetes under control should be high on your priority list. A 2017 study found that people who have both diabetes and A-fib have a higher rate of death than those with A-fib and stroke.
Whatever you do, don’t assume that you should leave your atrial fibrillation untreated just because you’re not experiencing symptoms. Research suggests that mortality rates are identical between atrial fibrillation patients who experience symptoms and those who do not.
