What is the clinical evidence from this study?

Study design: Observational. Population: Stroke and Atrial Fibrillation (n=490000). Primary outcome: Annual age-adjusted mortality rates (AAMR) per million (APC 1.1).

December 1, 2024Open Access

Temporal Trends in Mortality Related to Stroke and Atrial Fibrillation in the United States: A 21‐Year Retrospective Analysis of CDC‐WONDER Database

Key Result

Age-adjusted mortality rates for stroke and atrial fibrillation in the US decreased until 2008 (APC = -0.9) but subsequently increased through 2020 (APC = 1.1), with higher rates in women.

Study Design

Type

Observational (n=490,000)

Multicenter

Yes

Structured PICO

Population

Around 490,000 deaths reported between 1999 and 2020 from stroke and atrial fibrillation across the 25-85+ age group in the United States.

Outcome

Annual age-adjusted mortality rates (AAMR) per million from 1999 to 2020hard clinical

Mortality related to stroke and atrial fibrillation in the US decreased until 2008 but has been increasing since, highlighting the need for improved preventative measures and healthcare policy changes.

Main Result

Effect estimate: APC 1.1

Abstract

AIMS: Atrial Fibrillation (AF) is one of the most strongly associated risk factors for stroke. Our study aims to analyze changes in mortality from 1999 to 2020 in patients with AF and stroke. METHODS: Using the Centre for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER), we retrospectively analyzed annual age-adjusted mortality rates (AAMR) per million from 1999 to 2020 in stroke patients with AF. Temporal trends were analyzed, and Annual Percentage Change (APC) was calculated using the JoinPoint regression model across variations in demographics (sex, race) and regional subgroups. RESULTS: Around 490 000 deaths were reported between 1999 and 2020 from stroke and AF across the 25-85+ age group. AAMR initially decreased until 2008 (APC = -0.9), followed by an increase till 2020 (APC = 1.1). Women had a higher AAMR than men throughout the years. Non-Hispanic white patients had a marginally higher AAMR than all other races and ethnicities. The highest AAMR was observed in the western region. States like Vermont, Oregon, Washington, Alaska, Minnesota, and West Virginia were in the top 90th percentile, while Nevada, Louisiana, Florida, New York, New Mexico, and Arizona were in the bottom 10th percentile. Nonmetropolitan areas had consistently higher AAMRs throughout the 2 decades. CONCLUSION: An overall rise in mortality has been observed in stroke and AF patients, with a greater surge in 2019. The need for healthcare policy changes, especially in areas with high mortality and awareness of healthier lifestyle factors, can be an essential preventative measure to help mitigate growing mortality rates.