Key result
Concurrent HF, AF, and sepsis mortality rises ~100% from 1999 to 2020.
Why the study?
Heart failure, atrial fibrillation/flutter, and sepsis commonly co-occur in hospitalized patients, but temporal mortality trends associated with this concurrent triad across US demographic and geographic groups had not been determined.
Cohort (n=1,749,565)
Effect estimate: AAPC 3.21% (95% CI 2.99%-3.43%)
Absolute Event Rate: 23.87% vs 11.79%
Mortality involving concurrent heart failure, atrial fibrillation/flutter, and sepsis in the US has doubled from 1999 to 2023, with a marked acceleration post-2012 and no post-pandemic stabilization.
May warrant heightened awareness of HF-AF-sepsis mortality; leaves open causes of the post-2012 acceleration and reversal approaches.
Background Heart failure (HF), atrial fibrillation (AF)/atrial flutter (AFL) and sepsis commonly co-occur in hospitalized patients. This study determines temporal mortality trends associated with concurrent HF, AF/AFL, and sepsis among adults across demographic and geographic groups in the United States. Methods The CDC Wonder database was utilized to extract age-adjusted mortality rates (AAMR) per 100,000 for deaths listing HF, AF/AFL, and sepsis. Trends were analyzed by age, race/ethnicity, region, and sex. Joinpoint regression calculated the annual percent change (APC) and average annual percent change (AAPC) for AAMR with 95% CI. Results From 1999 to 2023, there were 1,749,565 deaths involving HF, AF/AFL, and sepsis. AAMR doubled (1999: 11.79 vs 2020: 23.87 per 100,000), with a critical 2012 inflection point accelerating mortality from 1.29% to 6.42% annually. White individuals had steepest post-2012 acceleration (6.67%), surpassing Black individuals by 2020 (24.88 vs 20.80 per 100,000). Males had higher AAMRs than females (28.69 vs 20.19 per 100,000 in 2020). Middle-aged adults (45-64 years) showed highest acceleration (9.98-10.30%), nearly double those aged ≥85 years (5.82%). The Midwest and South had steepest increases (7.07% and 7.11%). During 2018–2023, mortality continued increasing at 6.11% annually without stabilization. Conclusions Mortality involving HF, AF/AFL and sepsis doubled from 1999–2023 with sustained acceleration and no post-pandemic stabilization. Targeted interventions should focus on males, middle-aged adults, and high-risk regions with enhanced post-discharge care. Project Overview This is retrospective cohort study using CDC WONDER data (1999-2023). We analyzed 1,749,565 deaths involving all three conditions, heart failure, atrial fibrillation/flutter, and sepsis. To our knowledge, this is the first population-level study examining mortality trends due to the coexistence of heart failure, atrial fibrillation/flutter, and sepsis. Key Findings verall age-adjusted mortality rates doubled from 11.79 to 23.87 per 100,000 (1999-2020). was a critical inflection point in 2012 with marked acceleration thereafter. findings revealed significant demographic disparities regarding age, sex, race/ethnicity, and region. acceleration through 2023 was found without post-pandemic. stabilization.
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Shanmuganathan et al. (2026) conducted a cohort in Concurrent heart failure, atrial fibrillation/flutter, and sepsis (n=1,749,565). Concurrent heart failure, atrial fibrillation/flutter, and sepsis vs. Temporal trends (1999-2023) was evaluated on Age-adjusted mortality rate (AAMR) per 100,000 population (AAPC 3.21%, 95% CI 2.99%-3.43%). Age-adjusted mortality rates for concurrent heart failure, atrial fibrillation/flutter, and sepsis doubled from 11.79 to 23.87 per 100,000 between 1999 and 2020, with an average annual percent change of 3.21%.
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