Rising burden of coronary artery disease-related mortality among USA adults with atrial fibrillation from 1999 to 2020

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BACKGROUND: Coronary artery disease (CAD) and atrial fibrillation (AF) are significant cardiovascular conditions with substantial health and economic burdens. Despite advancements in treatment, long-term mortality trends among individuals with both conditions remain underexplored. This study investigates age-adjusted mortality rates (AAMRs) from 1999 to 2020 and examines trends to address these gaps and highlight demographic and geographic disparities. METHODS: Mortality data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database were analyzed for cases where CAD (ICD-10 codes I20-I25) and AF (ICD-10 code I48) were either contributing or underlying causes of death. Individuals aged 25 years and older were included in the analysis. AAMRs were calculated using direct standardization to the 2000 USA population, and trends were assessed using Joinpoint regression analysis. Mortality trends were stratified by sex, race, geography, and urbanization to identify disparities. RESULTS: Between 1999 and 2020, AAMRs for CAD- and AF-related mortality increased from 14.4 to 23.4 per 100 000, with an average annual percent change of +2.2% (95% confidence interval: 2.0-2.4). Men consistently exhibited higher overall AAMRs than women (22.9 vs. 13.1 ). Non-Hispanic (NH) White individuals had the highest AAMR (18.6), followed by NH American Indians (12.3), NH Blacks (10.0), Hispanics (9.4), and NH Asians (8.0). Rural areas experienced significantly higher AAMRs than urban areas (19.2 vs. 16.6). AAMRs were disproportionately higher in Western (17.7) and Midwestern USA regions (17.7). States in the top 90 th percentile reported nearly double the AAMRs compared to those in the bottom 10 th percentile. CONCLUSION: Mortality rates associated with coexisting CAD and AF have significantly increased, with the most pronounced rise occurring after 2018. The findings reveal substantial disparities across sex, race, and geography. Targeted interventions are essential to address these inequalities, improve health outcomes, and reduce the growing burden of CAD and AF-related mortality.

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