Temporal trends in mortality involving atrial fibrillation and rheumatic heart disease: a 25-year nationwide analysis

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Background Atrial fibrillation (AF) and rheumatic heart disease (RHD) can coexist with potential for serious complications. Trends involving both conditions remain unexplored and this study aims to explore them. Methods Nationwide mortality records were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER) database from 1999 to 2023 among U.S. adults >45 years with AF (ICD-10 code: I48) and RHD (I05-I09). Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population and stratified by demographic variables. Joinpoint regression analysis was used to determine the average and annual percent change (AAPC and APC). Results From 1999 to 2023, a total of 36,701 deaths were reported among individuals aged >45 years with AF and RHD in the U.S. The AAMR increased from 1.04 in 1999 to 2.00 in 2023 (AAPC: 2.78; p = 0.001). Women had higher overall AAMR (1.34) (AAPC: 2.48; p < 0.001) than men (1.06) (AAPC: 4.14; p < 0.001). Racially, the highest overall AAMR was in Non-Hispanic (NH) White (1.32) while the overall AAMR in Hispanics was (0.73). Regionally, the highest overall AAMR was noticed in the West (1.68), followed by the Midwest (1.36). The majority of deaths occurred in inpatient medical facilities (13,939 deaths, 38%). Rural areas had higher overall AAMR (1.2) compared to urban areas (1.1). Conclusion Trends in AF and RHD mortality increased lately. Higher trends observed in women, rural areas, the West region, NH white population and inpatient medical facilities.

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