Objective:

We aim to identify the mortality trends in patients with stroke and atrial fibrillation in the US, stratified by age, sex, race, and region.

Background:

Atrial fibrillation (AF), affecting 6 million individuals in the US, significantly increases the risk of stroke. By 2050, AF prevalence is projected to rise to 15.9 million, further elevating stroke risk. Understanding mortality trends in AF-related strokes is critical for public health efforts.

Design/Methods:

We extracted data from the CDC WONDER database for decedents ≥25 years old with atrial fibrillation and stroke listed on death certificates. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated. Joinpoint regression estimated the annual percent change (APC) and average APC (AAPC) in the rates.

Results:

From 1999-2020, 555,728 deaths were recorded with both AF and stroke. The AAMRs were stable until 2008 (APC: -0.56, 95% CI: -2.02 to 0.06), increased moderately from 2008-2018 (APC: 1.43, 95% CI: 0.00 to 1.98), and surged sharply by 2020 (APC: 5.25, 95% CI: 1.95 to 6.95). The AAMR was comparable for males (11.77) and females (11.44). Non-Hispanic Whites displayed the highest AAMR (12.37), while Hispanics or Latinos displayed the lowest (7.29). AAMRs varied by region (West: 13.64; Midwest: 11.84; South: 11.00; Northeast: 10.65). States with the highest AAMRs were Vermont (21.21) and Oregon (20.09). Rural regions exhibited a slightly higher AAMR (12.90) than urban ones (11.44). Adults aged ≥85 years had the highest CMR (246.79), nearly four times that of the 75-84 group (60.76).

Conclusions:

Mortality trends in AF-related strokes were initially stable but have risen since 2008, especially in older adults, non-Hispanic Whites, and residents of the West. Identifying and addressing the underlying risk factors is crucial for reducing these rising death rates.