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Published on: February 26, 2013
Heart Failure-Related Death in Subjects With Atrial Fibrillation in the United States, 1999 to 2020
Marco Zuin1, Matteo Bertini1, Francesco Vitali1
1Cardiology Unit, Department of Translational Medicine Sant'Anna University Hospital, University of Ferrara Ferrara Italy.
Insights
Heart failure deaths are rising in US adults with atrial fibrillation. This trend is particularly concerning in men, White individuals, and younger populations, with a notable increase observed after 2011.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Population-based data on heart failure (HF)-related mortality in patients with atrial fibrillation (AF) are limited.
- Understanding these trends is crucial for public health initiatives and clinical practice.
- Previous studies have not comprehensively assessed long-term mortality trends in this specific patient group.
Purpose of the Study:
- To assess trends in HF-related death among US adults with AF over a 21-year period (1999-2020).
- To examine demographic and regional differences in HF-related mortality within the AF population.
- To identify specific subgroups experiencing disproportionate increases in mortality.
Main Methods:
- Utilized the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database.
- Analyzed age-adjusted mortality rates per 100,000 individuals with AF aged 15 years and older.
- Employed joinpoint regression to calculate the average annual percent change (AAPC) and identify significant trend shifts.
Main Results:
- Over 916,000 HF-related deaths occurred in US adults with AF between 1999 and 2020.
- Overall age-adjusted mortality rates increased by 4.1% annually, with a steeper rise of 6.8% after 2011.
- Significant increases were observed in men (+4.8% AAPC), White individuals (+4.2% AAPC), and those under 65 years (+7.5% AAPC).
- The South region accounted for the highest percentage of deaths (32.8%).
- An excess of HF-related deaths was noted in patients over 65 during the first year of the COVID-19 pandemic.
Conclusions:
- A concerning upward trend in HF-related mortality among patients with AF has been identified in the US over the past two decades.
- Targeted interventions are needed to address rising mortality rates in specific demographic groups.
- Further research should investigate the factors contributing to this increase, especially in light of recent public health events.
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.
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