Variation and disparity in awareness of atrial fibrillation in China: A national cross-sectional study

Background: The latest information regarding the awareness of atrial fibrillation (AF) remains limited in China. Objectives: The present study aimed to understand the variation and disparity in awareness of AF in China. Methods: The cross-sectional study used data from the 2020 nationwide epidemiology survey on AF among adults aged 18 years or older in mainland China to assess the prevalence of AF awareness. The awareness of AF diagnostic methods and outcomes was also assessed using an interviewer-administered questionnaire. Results: Of the 114,039 adults responding to the survey, 1463 (age-standardized prevalence, 55.3% (95% confidence interval [CI], 47.7–62.9%) and 10,202 (8.2%, 95%CI 5.4–10.9%) were aware of AF in participants with and without AF, respectively. Of these, 36.4% (95%CI 30.0–42.9%) and 6.3% (95%CI 3.6–9.1%) considered electrocardiogram as a method of diagnosing AF, and 30.0% (95% CI 3.2–8.2%) and 5.2% (95%CI 2.7–7.6%) considered stroke as an outcome of AF. The proportion of participants who being aware of AF varied significantly across sociodemographic and cardiovascular disease subgroups, and was almost consistently lower in rural areas than those in urban areas. Overall, lack of AF awareness was associated with rural areas, geographical region, lower education levels, and without history and had no risk factors of cardiovascular disease. Conclusions: Nearly half of adults with AF, and >90% non-AF population are unaware of AF in China, with significant variation and disparity. Focused public health initiatives are needed to improve awareness and knowledge of AF among high-risk populations.