A silent surge: Increasing stroke deaths among older adults with atrial fibrillation in the United States (1999-2020)

BACKGROUND: Atrial fibrillation (AF) significantly increases stroke risk, particularly among older adults, leading to severe outcomes and elevated mortality. This study investigates trends and disparities in AF-related stroke mortality among U.S. adults aged 65 and older from 1999 to 2020. METHODS: Mortality data from the CDC WONDER database were analyzed, identifying stroke as the underlying cause of death (ICD-10 codes I60-I69) with AF as a contributing cause (ICD-10 code I48). Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated. Annual percentage change (APC) and average annual percentage change (AAPC) were used to assess trends over time using Joinpoint regression. RESULTS: A total of 197,453 deaths were recorded between 1999 and 2020. The AAMR increased from 20.85 in 1999 to 24.09 in 2020, reflecting an AAPC of 0.55 % (95 % CI: 0.19-0.95). Women had a slightly higher overall AAMR (21.69) compared to men (20.38). AAMR for Non-Hispanic (NH) Whites (22.15) was 1.5 times higher than that for Hispanics (14.17). Nonmetropolitan areas reported a higher AAMR (22.68) compared to metropolitan areas (21.03). The West had the highest regional overall AAMR (26.57). States in the top 90th percentile reported nearly double the rates of the lowest 10th percentile states. CONCLUSION: AF-related stroke mortality in older adults has risen over the past two decades, with disparities across gender, race, and geography. Targeted interventions are essential to address these disparities and reduce the burden of AF-related stroke mortality.