Trends in United States mortality among patients with atrial fibrillation/flutter related heart failure (1999–2024): disparities by gender, race/ethnicity and region
Abstract 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 paucit...
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2025-07-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-025-05036-5 |
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| author | Suraksha Rani Laksh Kumar Sheikh Muhammad Ebtehaj Ali Saad Ashraf Sunaina Bhimani Sumet Kumar Adarsh Raja Abdullah BS Biruk Demisse Ayalew Mohammad Hamza Bin Abdul Malik |
| author_facet | Suraksha Rani Laksh Kumar Sheikh Muhammad Ebtehaj Ali Saad Ashraf Sunaina Bhimani Sumet Kumar Adarsh Raja Abdullah BS Biruk Demisse Ayalew Mohammad Hamza Bin Abdul Malik |
| author_sort | Suraksha Rani |
| collection | DOAJ |
| description | Abstract 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. Objective 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 Between 1999 and 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 population. Males consistently exhibited higher AAMRs than females (15.7 vs. 12.3 per 100,000, respectively). 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. |
| format | Article |
| id | doaj-art-0b28311f058141139d7cfdb53005c6fa |
| institution | Kabale University |
| issn | 1471-2261 |
| language | English |
| publishDate | 2025-07-01 |
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| series | BMC Cardiovascular Disorders |
| spelling | doaj-art-0b28311f058141139d7cfdb53005c6fa2025-08-20T04:01:46ZengBMCBMC Cardiovascular Disorders1471-22612025-07-0125111410.1186/s12872-025-05036-5Trends in United States mortality among patients with atrial fibrillation/flutter related heart failure (1999–2024): disparities by gender, race/ethnicity and regionSuraksha Rani0Laksh Kumar1Sheikh Muhammad Ebtehaj Ali2Saad Ashraf3Sunaina Bhimani4Sumet Kumar5Adarsh Raja6Abdullah BS7Biruk Demisse Ayalew8Mohammad Hamza Bin Abdul Malik9Department of Medicine, Sir Syed College of Medical SciencesDepartment of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College LyariDepartment of Surgery, Abbasi Shaheed HospitalDepartment of Medicine, Dow Medical College, Dow University of Health SciencesDepartment of Medicine, Dow Medical College, Dow University of Health SciencesDepartment of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College LyariDepartment of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College LyariDepartment of Medicine, Rawalpindi Medical UniversitySt. Paul’s Hospital Millennium Medical CollegeNassau University Medical CenterAbstract 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. Objective 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 Between 1999 and 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 population. Males consistently exhibited higher AAMRs than females (15.7 vs. 12.3 per 100,000, respectively). 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.https://doi.org/10.1186/s12872-025-05036-5Heart failureAtrial fibrillationAtrial flutterUnited StatesMortality |
| spellingShingle | Suraksha Rani Laksh Kumar Sheikh Muhammad Ebtehaj Ali Saad Ashraf Sunaina Bhimani Sumet Kumar Adarsh Raja Abdullah BS Biruk Demisse Ayalew Mohammad Hamza Bin Abdul Malik Trends in United States mortality among patients with atrial fibrillation/flutter related heart failure (1999–2024): disparities by gender, race/ethnicity and region BMC Cardiovascular Disorders Heart failure Atrial fibrillation Atrial flutter United States Mortality |
| title | Trends in United States mortality among patients with atrial fibrillation/flutter related heart failure (1999–2024): disparities by gender, race/ethnicity and region |
| title_full | Trends in United States mortality among patients with atrial fibrillation/flutter related heart failure (1999–2024): disparities by gender, race/ethnicity and region |
| title_fullStr | Trends in United States mortality among patients with atrial fibrillation/flutter related heart failure (1999–2024): disparities by gender, race/ethnicity and region |
| title_full_unstemmed | Trends in United States mortality among patients with atrial fibrillation/flutter related heart failure (1999–2024): disparities by gender, race/ethnicity and region |
| title_short | Trends in United States mortality among patients with atrial fibrillation/flutter related heart failure (1999–2024): disparities by gender, race/ethnicity and region |
| title_sort | trends in united states mortality among patients with atrial fibrillation flutter related heart failure 1999 2024 disparities by gender race ethnicity and region |
| topic | Heart failure Atrial fibrillation Atrial flutter United States Mortality |
| url | https://doi.org/10.1186/s12872-025-05036-5 |
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