To analyze the disease burden, changing trends, and differences of atrial fibrillation (AF)/atrial flutter (AFL) globally and in China and Japan from 1990 to 2021, and to predict their future trends, aiming to provide references for health decision-making.

Based on the Global Burden of Disease Study Database 2021 (GBD 2021), we extracted age-standardized prevalence rate (ASPR) and age-standardized disability-adjusted life year rate (ASDALYR) data for AF/AFL by sex globally, in China, and Japan. The estimated annual percentage change (EAPC) was used to assess the trends. Joinpoint regression analysis and the Bayesian age-period-cohort (BAPC) model were employed for trend analysis and prediction.

From 1990 to 2021, the ASPR and ASDALYR for AF/AFL in males were increased significantly globally, with EAPC of 0.05 (95%CI: 0.01~0.08) and 0.09 (95%CI: 0.08~0.11), respectively. Changes were significantly declined in females,with EAPC of -0.11(95%CI: -0.14~-0.07)and -0.10(95%CI:-0.12~-0.07). In China, the ASPR for AF/AFL were increased in both males and females, with those of males more notably (EAPC=0.77, 95%CI: 0.65~0.88). However, the ASDALYR for AF/AFL showed gender divergence, with an increase in males (EAPC=0.40, 95%CI: 0.30~0.49) while a decrease in females (EAPC=-0.55, 95%CI: -0.67~-0.44). In Japan, both the ASPR and ASDALYR for males and females showed continuous declines, and the reduction was more pronounced among females (ASPR EAPC=-1.77, 95%CI:-2.32~-1.22; ASDALYR EAPC=-1.73, 95%CI:-2.11~-1.35). Joinpoint regression analysis showed that from 1990 to 2021, for the ASDALYR of AF/AFL, the average annual percentage change (AAPC) was 0.28% (P<0.001) for Chinese males and -0.37% (P<0.001) for Chinese females, while the AAPC was -0.70% (P<0.001) and -1.43% (P<0.001) for Japanese males and females. BAPC model revealed that by 2036, the ASDALYR for Chinese males is predicted to increase from 91.45 per 100 000 in 2022 to 101.11 per 100 000, and for females is from 88.85 per 100 000 to 100.98 per 100 000. For Japanese males, the ASDALYR is projected to increase slightly from 88.79 to 89.86 per 100 000, while for females, it is projected decrease slightly from 41.13 to 39.67 per 100 000, indicating only minor fluctuations in the ASDALYR for both Japanese males and females.

The disease burden of AF/AFL continues to increase globally and in China. So, Japan’s lifestyle and health policies are worth considering, and more scientific and effective public health policies and clinical intervention strategies should be formulated and implemented. Countermeasure　The relevant government agencies should promote the transformation of the food industry through the policy-market mechanism, carry out activities related to national health management, and continuously optimize the AF/AFL management model of medical and health institutions to effectively cope with this disease burden change.