Abstract WE474: Trends and Disparities in Heart Failure and Atrial Fibrillation-Related Mortality in the United States – A Nationwide Retrospective Analysis

Abstract

Background: Atrial fibrillation (AF) is a significant contributor to heart failure (HF) exacerbations and associated with significant mortality and morbidity, however limited research has evaluated temporal trends in morality and disparities associated with concurrent AF and HF. Methods: Using the CDC WONDER database, we analyzed mortality trends related to concurrent AF and HF in individuals aged 25 and older in the United States from 1999-2023. Age-adjusted mortality rates (AAMR) per 100,000 individuals were calculated and stratified by year, race, gender, urbanization, geographic region, and place of death. Trends were assessed via annual percentage change (APCs) and average annual percentage changes (AAPC) using the Joinpoint regression software. Statistical significance was defined as p <0.05. Results: Between 1999-2023, there were a total of 1,110,367 deaths related to concurrent HF and AF in the United States. The overall AAMR has steadily increased between 1999-2023 (AAPC: 4.2%) with statistically significant spikes from 1999-2010 (APC 1.99%, CI 1.52-2.47), 2010-2018 (APC 5.72%, CI 4.95-6.50), and 2018-2021 (APC 9.56%, CI 5.10-14.20). Males exhibited higher overall AAMRs compared to females while both groups had a steady rise in mortality rates between 1999-2021(Figure 1). Non-Hispanic (NH) White individuals had the highest AAMRs followed by NH Black, American Indian, Hispanic, and Asian individuals (Figure 2). NH Black individuals exhibited the highest rise in AAMRs from 2018 to 2021 (APC 12.5%, 95% CI 0.122-26.5, P<0.05). The overall mortality was highest in the West (AAMR 20.4) while the Midwest had the highest rise in mortality (AAMR 12.9 in 1999 to 35.15 in 2023) (Figure 3). Most deaths (350,199) occurred in inpatient medical facilities (30%), 309,69 in nursing homes (26.52%), and 296,745 in decedent’s homes (25.4%). AAMRs stratified by urban vs. rural geographic regions were only available from 1999-2020 and were higher in non-metropolitan areas at 20.50 (CI 20.4-20.6) compared with large metropolitan areas at 15.3 (CI 15.3-15.4) (Figure 4). Conclusion: Concurrent HF and AF-related mortality has increased across all demographic groups in the United States in the past two decades with the highest rates observed among men, African American, White, and non-metropolitan populations. Recognizing persistent disparities is essential to informing targeted preventive interventions aimed at reducing the burden of AF and HF affecting millions worldwide.