Trends and disparities in mortality involving aortic stenosis and atrial fibrillation among United States adults aged ≥ 55 years: a 26-year CDC WONDER analysis (1999–2024)

Introduction Aortic stenosis (AS) and atrial fibrillation (AF) frequently coexist in older adults and are associated with increased cardiovascular risk. National mortality trends involving both conditions remain incompletely characterized. Methods We performed a nationwide ecological time-trend analysis using the CDC WONDER Multiple Cause of Death database from 1999 to 2024. Adults aged ≥ 55 years with both AS (ICD-10 I35.0) and AF (ICD-10 I48) listed on the death certificate were included. Age-adjusted mortality rates (AAMRs) per 100,000 populations were analyzed overall and by sex, race/ethnicity, census region, urbanization, and place of death. Temporal trends were assessed using Joinpoint regression. Results A total of 94,542 deaths involving AS and AF were identified. Overall AAMR increased from 2.4 (95% confidence interval [CI], 2.3–2.6) in 1999 to 7.4 (95% CI, 7.2–7.6) in 2024, with a significant overall increase (average annual percent change [AAPC], 5.08%; p < 0.001). Mortality remained higher among males than females (2024 AAMR: 9.2 vs. 6.1 per 100,000). NH White individuals had the highest mortality rates, while all racial and ethnic groups demonstrated significant increases over time. Mortality was highest in the Western United States and in non-metropolitan areas. Most deaths occurred in inpatient facilities (33.8%), followed by home (29.0%) and nursing homes or long-term care facilities (22.6%). Conclusion Mortality involving coexisting AS and AF increased more than threefold among U.S. adults aged ≥ 55 years between 1999 and 2024. Persistent demographic and geographic disparities highlight the need for earlier diagnosis and improved access to guideline-directed care. Clinical trial number Not applicable.