Nationwide trends and disparities in deaths from second- or third-degree atrioventricular block (1999–2022): A 24-year retrospective analysis of CDC WONDER data

Q: What are the key findings of this study?

Mortality from second- and third-degree AV block in the US rose sharply from 2013 to 2022 with an annual percent change of 7.26, following an initial significant decline from 1999 to 2007.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Second- or third-degree atrioventricular block (n=54420). Intervention: Time period (1999-2022) vs. Temporal baseline (1999). Primary outcome: Age-adjusted mortality rate (AAMR) per 1,000,000 and Annual Percent Change (APC) (APC 7.26, 95% CI 6.12-9.96, p=<0.001).

Q: What does this research mean for the field?

Mortality from second- and third-degree atrioventricular block in the U.S. has increased since 1999, with disproportionately higher rates in men, older adults, Non-Hispanic American Indian or Alaska Native individuals, and non-metropolitan areas. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Humza Saeed; Samia Aziz Sulaiman; Abdullah Abdullah; Priya Goyal; Kamya Thakkar; Wania Sultan; J. Mayo; Muhammad Khubaib Arshad; Ajeet Singh; Mohamed Daoud; Hritvik Jain

doi:10.1016/j.ahjo.2025.100680

November 20, 2025American Heart Journal Plus Cardiology Research and PracticeOpen Access

Nationwide trends and disparities in deaths from second- or third-degree atrioventricular block (1999–2022): A 24-year retrospective analysis of CDC WONDER data

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Key result

US mortality from advanced AV block rose ~7% annually from 2013 to 2022.

APC 7.26
95% CI 6.12-9.96
P<0.001
n=54,420

Figures

Why the study?

Analyzing mortality trends in second- or third-degree AV blocks in the U.S. is vital for treatment and identifying at-risk populations.

Study Design

Type

Observational (n=54,420)

Structured PICO

P

Population

54,420 adults aged 25 and older with second- or third-degree atrioventricular block listed as a cause of death in the United States between 1999 and 2022.

O

Outcome

Age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and annual percent change (APC) for second- or third-degree AV block deathshard clinical

Main Result

Effect estimate: APC 7.26 (95% CI 6.12-9.96)

Absolute Event Rate: 14.9% vs 12.8%

p-value: p=<0.001

Limitations

Reliance on death certificates and ICD codes may include inaccuracies in reporting the actual cause of death
Lack of detailed clinical information, such as vital signs, laboratory results, and echocardiographic data
Unmeasured confounding factors (e.g., comorbidities, access to care) could not be adjusted via multivariate analyses
Information on device therapy such as pacemaker implantation was not available in the dataset
Exclusion of suppressed counts (1-9 deaths) and unreliable rates (<20 deaths) limits interpretation of sparse demographic subgroups
Descriptive analysis based on aggregated mortality data cannot infer causality
Reliance solely on death certificates and ICD codes may include inaccuracies
Lack of detailed clinical information such as vital signs, laboratory results, and echocardiographic data
Unmeasured confounding factors
Information on device therapy such as pacemaker implantation is not available in the dataset
Findings cannot necessarily be generalized to other populations outside the United States
Exclusion of suppressed counts (1-9 deaths) and unreliable rates (<20 deaths) limits interpretation of some subgroups
Causality cannot be inferred

Implication

Mortality associated with second- and third-degree AV block in the US has increased significantly since 2013, with notable disparities disproportionately affecting men, older adults, Non-Hispanic American Indian or Alaska Native populations, and non-metropolitan areas.

Abstract

Background: AV block prevalence increases with age: first-degree affects 6 % of adults over 60 with low mortality, second-degree is more serious, and third-degree, though rare (0.02 % in the U.S.), has a 37 % five-year survival rate if untreated. Analyzing mortality trends in second- or third-degree AV blocks in the U.S. is vital for treatment and identifying at-risk populations. Methodology: We analyzed death certificates from the CDC WONDER database (1999-2022) for second- and third-degree AV Block (ICD-10 codes I44.1 and I44.2) in individuals aged 25 and older. Age-adjusted mortality rates (AAMRs) and annual percent change (APC) were calculated by year, sex, age, race/ethnicity and geographics. Older adults had higher AAMRs (45.0) compared to middle-aged (2.1) and young adults (0.3). Men had higher AAMRs than women (11.3 vs. 8.6). Ethnoracial disparities showed the highest AAMRs in NH American Indian individuals (13.3), followed by NH Black (10.5), NH White (9.8), Hispanic (7.3), and NH Asian individuals (5.9). Non-metropolitan areas had higher AAMRs than metropolitan areas (11.7 vs. 9.2). Conclusions: Mortality from second- and third-degree AV block has increased since 1999, particularly in the last decade, with higher rates in men, older adults, NH American Indian or Alaska Native individuals, and non-metropolitan areas, highlighting the need for further research to address these disparities.

Discussion

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Cite This Study

Saeed et al. (2025) conducted an observational in Second- or third-degree atrioventricular block (n=54,420). Time period (1999-2022) vs. Temporal baseline (1999) was evaluated on Age-adjusted mortality rate (AAMR) per 1,000,000 and Annual Percent Change (APC) (APC 7.26, 95% CI 6.12-9.96, p=<0.001). Mortality from second- and third-degree AV block in the US rose sharply from 2013 to 2022 with an annual percent change of 7.26, following an initial significant decline from 1999 to 2007.

synapsesocial.com/papers/6a1d90a228423f2ce505384a https://doi.org/10.1016/j.ahjo.2025.100680

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Nationwide trends and disparities in deaths from second- or third-degree atrioventricular block (1999–2022): A 24-year retrospective analysis of CDC WONDER data

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Nationwide trends and disparities in deaths from second- or third-degree atrioventricular block (1999–2022): A 24-year retrospective analysis of CDC WONDER data

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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