What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation and congestive heart failure with underlying ischemic heart disease (n=219188). Primary outcome: Age-adjusted mortality rate (AAMR) and average annual percent change (AAPC) (AAPC 0.64%, 95% CI 0.36-0.91, p=<0.001).

What does this research mean for the field?

Mortality rates involving atrial fibrillation and heart failure with underlying ischemic heart disease among older U.S. adults reversed their initial decline after 2010 and are now rising, with significant disparities disproportionately affecting males, non-Hispanic Black adults, and non-metropolitan populations. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate national mortality trends, demographic disparities, and future projections for deaths involving atrial fibrillation and congestive heart failure with underlying ischemic heart disease among older adults in the United States.

March 21, 2026Journal of Epidemiology and Global HealthOpen Access

National Mortality Trends, Disparities, and Forecasted Burden of Atrial Fibrillation and Heart Failure with Underlying Ischemic Heart Disease Among Older Adults in the United States, 1999–2023

Q: What are the key findings of this study?

Mortality rates for atrial fibrillation and heart failure with underlying ischemic heart disease among US adults aged ≥65 years increased significantly with an AAPC of 0.64% from 1999 to 2023.

Q: What does this research mean for the field?

Mortality rates involving atrial fibrillation and heart failure with underlying ischemic heart disease among older U.S. adults reversed their initial decline after 2010 and are now rising, with significant disparities disproportionately affecting males, non-Hispanic Black adults, and non-metropolitan populations. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate national mortality trends, demographic disparities, and future projections for deaths involving atrial fibrillation and congestive heart failure with underlying ischemic heart disease among older adults in the United States.

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Key result

Mortality for AF and HF with underlying IHD rises ~0.6% annually in older US adults.

AAPC 0.64%
95% CI 0.36-0.91
P<0.001
n=219,188

Why the study?

AF and CHF amplify mortality risk in IHD, and although IHD mortality declined in the early 2000s, recent data suggest a resurgence.

Key Points

To evaluate national mortality trends, demographic disparities, and future projections for deaths involving atrial fibrillation and congestive heart failure with underlying ischemic heart disease among older adults in the United States.
Analyzed death records from the CDC WONDER database (1999–2023) for adults aged ≥ 65 years with atrial fibrillation (ICD-10 I48) and congestive heart failure (I50.0) as multiple causes of death and ischemic heart disease (I20–I25) as the underlying cause.
Calculated crude mortality rates and age-adjusted mortality rates (AAMRs) per million, modeled trend inflection points using Joinpoint regression, and projected mortality rates through 2035 using ARIMA modeling.
Across 219,188 total deaths, the overall AAMR rose from 193.8 per million in 1999 to 220.1 per million in 2023 (overall AAPC 0.64%, 95% CI 0.36–0.91; p < 0.001), shifting from an initial decline into a sustained post-2010 surge (APC 1.60%, 95% CI 1.11–2.55; p < 0.001).
Sex trends diverged significantly: males (108,732 deaths) experienced a substantial increase (AAPC +1.40%, 95% CI 1.15–1.66; p < 0.001), whereas females (110,456 deaths) had an overall decline (AAPC −0.55%, 95% CI −0.87 to −0.25; p < 0.001).
Non-Hispanic Black adults experienced the highest racial increase (AAPC +1.21%, p < 0.001), while non-metropolitan rural areas had higher average mortality (AAMR 236.80) and faster growth (AAPC 1.37%, 95% CI 0.94–1.80; p < 0.001) than urban areas.

Study Design

Type

Observational (n=219,188)

Structured PICO

Population

Adults aged ≥ 65 years in the United States with deaths where ischemic heart disease was the underlying cause and both atrial fibrillation/flutter and congestive heart failure were contributing causes.

Outcome

Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 1,000,000 population, and temporal trends (annual percent change and average annual percent change).hard clinical

Main Result

Effect estimate: AAPC 0.64% (95% CI 0.36-0.91)

p-value: p=<0.001

Mortality rates for older U.S. adults with atrial fibrillation and heart failure driven by underlying ischemic heart disease have steadily increased since 2010, with significant disparities across sex, race, and geography.

Limitations

Reliance on ICD-10 coding subject to misclassification or variability in documentation practices
Temporal relationship between atrial fibrillation, heart failure, and ischemic heart disease cannot be determined from death certificates
Lack of individual-level clinical information, socioeconomic status, and genetic factors
Residual confounding due to unmeasured risk factors
Geographic variation in reporting practices and healthcare access
Cause-of-death classification relies on ICD-10 coding and may be subject to misclassification or variability in documentation practices.
The temporal relationship between atrial fibrillation, heart failure, and ischemic heart disease cannot be determined from death certificate data alone.
Individual-level clinical information, including severity of disease, treatment patterns, socioeconomic status, and genetic factors, was unavailable.
Residual confounding due to unmeasured risk factors cannot be excluded.
Geographic variation in reporting practices and healthcare access may influence observed mortality differences.

Implication

Warrants renewed focus on integrated AF-HF care in older adults with IHD; extends evidence of post-2010 cardiovascular mortality resurgence.

Abstract

Atrial fibrillation (AF) and congestive heart failure (CHF) remain major contributors to cardiovascular mortality in the United States. When accompanied by underlying ischemic heart disease (IHD), mortality risk is amplified. Although IHD mortality declined in the early 2000s, recent data suggest a resurgence. This population-based study used the CDC Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database from 1999 to 2023. Deaths were identified using ICD-10 codes I48 (AF) and I50.0 (CHF) as multiple causes of death and I20–I25 (IHD) as the underlying cause. Adults aged ≥ 65 years were included. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) were calculated. Temporal trends were analyzed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Future mortality trends were projected using autoregressive integrated moving average (ARIMA) model. From 1999 to 2023, AF, CHF, and IHD accounted for 219,188 deaths among adults ≥ 65 years. The overall AAMR increased from 193.8 per million in 1999 to 220.1 per million in 2023, with a decline from 1999 to 2010 followed by a sustained rise. Males (108,732 deaths) showed the steepest increase (AAPC + 1.40%, p < 0.001), whereas females (110,456 deaths) experienced a modest decline (AAPC − 0.55%, p < 0.001). Non-Hispanic Black adults had the largest racial increase (AAPC + 1.21%, p < 0.001). Non-metropolitan areas showed the greatest geographic rise (AAPC + 1.67%, p < 0.001). Mortality involving AF and CHF with underlying IHD among U.S. adults ≥ 65 years declined only temporarily before reversing after 2010. Persistent racial and geographic disparities underscore gaps in prevention and acute cardiovascular care. Not applicable.

Discussion

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Published by Journal of Epidemiology and Global Health · CC BY

Cite This Study

Ahmed et al. (2026) conducted an observational in Atrial fibrillation and congestive heart failure with underlying ischemic heart disease (n=219,188). Mortality rates for atrial fibrillation and heart failure with underlying ischemic heart disease among US adults aged ≥65 years increased significantly with an AAPC of 0.64% from 1999 to 2023.

synapsesocial.com/papers/69be37b96e48c4981c677891 https://doi.org/10.1007/s44197-026-00535-w

Topics

Atrial fibrillation

Heart failure

Persistent AF management

HFrEF treatment

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Implication

Warrants renewed focus on integrated AF-HF care in older adults with IHD; extends evidence of post-2010 cardiovascular mortality resurgence.

National Mortality Trends, Disparities, and Forecasted Burden of Atrial Fibrillation and Heart Failure with Underlying Ischemic Heart Disease Among Older Adults in the United States, 1999–2023

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Topics

National Mortality Trends, Disparities, and Forecasted Burden of Atrial Fibrillation and Heart Failure with Underlying Ischemic Heart Disease Among Older Adults in the United States, 1999–2023

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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