Abstract Body (Do not enter title and authors here): Background
Atrial fibrillation (AFib) and atrial flutter (AFL) are common arrhythmias associated with increased stroke risk. This study examines stroke mortality trends and gender differences among AFib/AFL patients in the United States over a 22-year period.

Research Question
Do stroke mortality rates among patients with AFib/AFL show significant trends and gender differences from 1999 to 2020?

Aims
The primary aim is to analyze trends in crude and age-adjusted stroke mortality rates and determine gender-specific differences over the 22-year period.

Methods
We conducted a retrospective analysis using CDC multiple causes of death files from 1999 to 2020. Stroke deaths (ICD-10 codes I60-I69) with AFib/AFL (ICD-10 code I48) as contributory factors were identified. Crude and age-adjusted mortality rates were calculated annually. Joinpoint regression calculated annual percentage change (APC) and assessed trend significance (p < 0.05). Poisson regression was used for rate comparisons. Gender-specific trends highlighted differences between males and females.

Results
The analysis included 204,127 stroke deaths with AFib/AFL. Both crude and age-adjusted mortality rates increased. The crude mortality rate rose from 3.3 per 100,000 in 1999 to 4.9 per 100,000 in 2020, APC 1.8% (p < 0.01). The age-adjusted rate increased from 3.4 to 4.0 per 100,000, APC 1.2% (p < 0.01). Females had higher crude mortality rates, increasing from 4.3 to 5.5 per 100,000, APC 1.3% (p < 0.01), while males rose from 2.3 to 4.2 per 100,000, APC 2.2% (p < 0.01). Age-adjusted rates: females increased from 3.4 to 3.9 per 100,000, APC 0.8% (p < 0.01), and males from 3.3 to 4.2 per 100,000, APC 1.6% (p < 0.01). Poisson regression indicated these differences were significant (p < 0.05). Age adjustment narrowed gender disparity.

Conclusion
Increasing stroke mortality rates among AFib/AFL patients highlight a growing public health concern in the United States. Females have higher crude stroke mortality rates than males, but age adjustment reveals a more balanced trend. More work is needed to understand influencing factors, including anticoagulation rates, healthcare access, and AFib/AFL management strategies.