Background:
Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and the prevalence is increasing due to the aging of the population and the growing burden of vascular risk factors. Although deaths due to cardiovascular disease (CVD) death have dramatically decreased in recent years, trends in AF-related CVD death has not been previously investigated.
Purpose:
We sought to quantify trends in AF-related CVD death rates in the United States.
Methods:
AF-related CVD death was ascertained using the CDC WONDER online database. AF-related CVD deaths were identified by listing CVD (I00-I78) as underlying cause of death and AF (I48) as contributing cause of death among persons aged 35 to 84 years. We calculated age-adjusted mortality rates (AAMR) per 100,000 population, and examined trends over time estimating average annual percent change (AAPC) using Joinpoint Regression Program (National Cancer Institute). Subgroup analyses were performed to compare AAMRs by sex-race (black and white men and women) and across two age groups (younger: 35-64 years, older 65-84 years).
Results:
A total of 522,104 AF-related CVD deaths were identified between 1999 and 2017. AAMR increased from 16.0 to 22.2 per 100,000 from 1999 to 2017 with an acceleration following an inflection point in 2009. AAPC before 2009 was significantly lower than that after 2009 [0.4% (95% CI, 0.0 - 0.7) vs 3.5% (95% CI, 3.1 - 3.9), p < 0.001). The increase of AAMR was observed across black and white men and women overall and in both age groups (FIGURE), with a more pronounced increase in black men and white men. Black men had the highest AAMR among the younger decedents, whereas white men had the highest AAMR among the older decedents.
Conclusion:
This study revealed that death rate for AF-related CVD has increased over the last two decades and that there are greater black-white disparities in younger decedents (<65 years). Targeting equitable risk factor reduction that predisposes to AF and CVD mortality is needed to reduce observed health inequities.
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