Key result
Co-listed AF and respiratory failure mortality climbed ~5-fold between 1999 and 2024.
Why the study?
Atrial fibrillation and respiratory failure frequently co-occur in critically ill patients, but long-term national trends in deaths recording both conditions were unknown.
Observational (n=462,284)
U.S. population mortality involving both atrial fibrillation and respiratory failure rose roughly five-fold over 25 years independently of COVID-19 and co-listed heart failure, highlighting a growing burden across demographic and rural-urban subgroups.
May warrant clinical vigilance for comorbid AF and respiratory failure; extends descriptive trends but leaves causal mechanisms open.
Background Atrial fibrillation (AF) and respiratory failure (RF) frequently co‐occur in critically ill patients, but long‐term national trends in deaths recording both remain unknown. Methods CDC WONDER multiple‐cause‐of‐death data identified U.S. adults aged ≥ 55 years with both AF (including atrial flutter) and RF listed on death certificates from 1999 to 2024. Age‐adjusted mortality rates (AAMRs) and annual percent changes (APCs) were estimated using joinpoint regression. Sensitivity analyses included adults aged ≥ 25 years, exclusion of COVID‐19‐related deaths, and stratification by co‐listed heart failure (HF). Results A total of 462 284 deaths listed both AF and RF. The AAMR increased roughly five‐fold (7.84 to 41.76 per 100 000), rising steadily through 2018 (APC 7.81), accelerating through 2021 (APC 18.78), and declining thereafter (APC −5.90). Excluding deaths listing COVID‐19, the 2018–2021 acceleration was not detected, and AAMRs rose through 2024 (2017–2024 APC 5.25). AAMRs for deaths without HF recorded rose over fourfold. Mean AAMRs were higher in males (26.19) than in females (19.04) and in non‐Hispanic (NH) White adults (24.06) than in other groups. The West and nonmetropolitan areas had the highest rates. The 2018–2021 surge was steepest among Hispanic (APC 25.62) and NH Black adults (APC 24.06). Conclusions Population mortality rates for deaths recording both AF and RF increased substantially over 25 years, beginning before the COVID‐19 pandemic, persisting after excluding deaths listing COVID‐19, and occurring with and without HF recorded. These data cannot separate changes in disease occurrence from changes in diagnosis or coding.
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Hassan et al. (2026) conducted an observational in Atrial fibrillation (including atrial flutter) and respiratory failure (n=462,284). Co-listed atrial fibrillation and respiratory failure on death certificates was evaluated on Age-adjusted mortality rate (AAMR) per 100,000 population and average annual percent change (AAPC) from 1999 to 2024 (AAPC 7.30, 95% CI 6.89-7.74, p=<0.05). Co-listed atrial fibrillation and respiratory failure age-adjusted mortality rates increased roughly five-fold from 7.84 to 41.76 per 100,000 between 1999 and 2024 (AAPC 7.30%, 95% CI 6.89-7.74).
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