Abstract Body (Do not enter title and authors here): Background:
Atrial fibrillation (AF) and heart failure (HF) are prevalent cardiovascular disorders that frequently co-occur, exacerbating each other's effects and resulting in adverse clinical outcomes. Despite the well-established association between these conditions, there is a paucity of research examining AF/atrial flutter (AFL) as direct contributors to HF-related mortality across various demographics and regions within the United States
Hypothesis:
This study aims to investigate the patterns of AF/AFL-related HF mortality in the U.S. from 1999 to 2024, stratified by age, gender, race/ethnicity, urban-rural classification, and geographic region.
Methods:
A retrospective analysis was conducted utilizing data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Mortality data were extracted from death certificates that identified AF/AFL related HF as a primary or contributing cause of death (ICD-10 codes I11.0, I13.0, I13.2, I48 and I50). Age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated, and annual percentage changes (APC) were assessed using Joinpoint regression.
Results:
From 1999 to 2024, 1,307,809 deaths in the United States were attributed to atrial fibrillation/flutter-related heart failure (AF/AFL-HF). The age-adjusted mortality rate (AAMR) rose significantly from 8.2 to 24.3 per 100,000. Males consistently had higher AAMRs than females (15.7 vs. 12.3). Racial disparities were evident, with non-Hispanic Whites having the highest cumulative AAMR (15.1), and non-Hispanic Asians/Pacific Islanders the lowest (5.7). Geographic differences were also prominent: Oregon recorded the highest state-level AAMR (25.5), while Hawaii had the lowest (8.8). Regionally, the West (15.3) and Midwest (14.9) had the highest cumulative AAMRs. Place-of-death trends showed a shift toward home deaths, which became the most common location by 2024. Although AAMRs increased sharply from 2010 to 2021 across most subgroups, rates stabilized between 2021 and 2024.
Conclusion:
AF/AFL-related heart failure mortality has increased substantially over the past 26 years in the U.S. with marked disparities by sex, race/ethnicity, region, and urbanization. While recent years have seen a plateau in mortality rates, the continued burden—especially among vulnerable populations underscores the need for equitable, targeted public health interventions and improved access to cardiovascular care.