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. 2024 May 7;13(9):e033897.
doi: 10.1161/JAHA.123.033897. Epub 2024 Apr 30.

Heart Failure-Related Death in Subjects With Atrial Fibrillation in the United States, 1999 to 2020

Marco Zuin  1 , Matteo Bertini  1 , Francesco Vitali  1 , Mintu Turakhia  2 , Giuseppe Boriani  3
Affiliations

Heart Failure-Related Death in Subjects With Atrial Fibrillation in the United States, 1999 to 2020

Marco Zuin et al. J Am Heart Assoc. .

Abstract

Background: Population-based data on heart failure (HF)-related death in patients with atrial fibrillation (AF) are lacking. We assessed HF-related death in people with AF in the United States over the past 21 years and examined differences by age, sex, race, ethnicity, urbanization, and census region.

Methods and results: Data were extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research to determine trends in age-adjusted mortality rates per 100 000 people, due to HF-related death among subjects with AF aged ≥15 years. To calculate nationwide annual trends, we assessed the average annual percent change (AAPC) and annual percent change with relative 95% CIs using joinpoint regression. Between 1999 and 2020, 916 685 HF-related deaths (396 205 men and 520 480 women) occurred among US adults having a concomitant AF. The overall age-adjusted mortality rates increased (AAPC: +4.1% [95% CI, 3.8-4.4]; P<0.001), especially after 2011 (annual percent change, +6.8% [95% CI, 6.2-7.4]; P<0.001) in men (AAPC, +4.8% [95% CI, 4.4-5.1]; P<0.001), in White subjects (AAPC: +4.2% [95% CI, 3.9 to 4.6]; P<0.001) and in subjects aged <65 years (AAPC: +7.5% [95% CI, 6.7-8.4]; P<0.001). The higher percentage of deaths were registered in the South (32.8%). During the first year of the COVID-19 pandemic, a significant excess in HF-related deaths among patients with AF aged >65 years was observed.

Conclusions: A worrying increase in the HF-related mortality rate among patients with AF has been observed in the United States over the past 2 decades.

Keywords: atrial fibrillation; death; heart failure; trends.

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Figures

Figure 1
Figure 1. Proportional death and HF‐related death in patients with AF according to age groups.
A, Proportional death over time. This is defined as the ratio between the number of HF‐related deaths in subjects with AF per 1000 deaths due to all causes. B, Percentages of HF‐related death in US subjects with AF by age groups, 1999 to 2020. AF indicates atrial fibrillation; and HF, heart failure.
Figure 2
Figure 2. Trends in age‐adjusted mortality rates related to heart failure in subjects with atrial fibrillation, in the United States, 1999 to 2020.
APC indicates annual percent change.
Figure 3
Figure 3. Trends in age‐adjusted mortality rates related to heart failure in subjects with atrial fibrillation, stratified by sex, in the United States, 1999 to 2020.
APC indicates annual percent change.
Figure 4
Figure 4. Changes in the first underlying causes of deaths among patients with HF having concomitant AF.
A, Ischemic heart disease; B, hypertensive heart disease; C, cardiomyopathy; D, stroke; and E, COPD. AF indicates atrial fibrillation; COPD, chronic obstructive pulmonary disease; and HF, heart failure.
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