Abstract 4139880: Trends in Atrial Fibrillation Related Mortality in Coronary Artery Disease Patients Aged 65 and Older in the United States: Insights from the CDC WONDER Database

Background: Patients with Coronary Artery Disease are at an increased risk of Atrial Fibrillation related mortality via various mechanisms like Ischemia, Atrial stretch and remodeling, but largely as side effects of treatments. Thus, AF in patients with CAD is a critical health concern among older adults (65+) in the United States. Our CDC analysis focuses on unraveling mortality trends among patients grappling with both conditions from 1999 to 2020. Methods: A retrospective analysis was conducted using national mortality data from the multiple causes of death files in the CDC WONDER database from 1999 to 2020, employing ICD codes I48 for AF and I25.1 for CAD. Age-adjusted mortality rates (AAMRs) per 100,000 people were calculated for the total population, stratified by gender, race, urban/rural metro status, and census region. Annual Percent Change (APC) was calculated using the Joinpoint regression software. Results: A total of 564,952 AF-related deaths among older adults aged 65+ with CAD occurred in the U.S. between 1999 and 2020. Majorly occurred in medical facilities (36.5%). The overall AAMR for AF in CAD-related deaths increased from 49.7 per 100,000 in 1999 to 84.4 in 2020, with an AAPC of 2.52 (95% CI: 2.29 to 2.76, p < 0.000001). A moderate rise in AAMR from 1999 to 2016 (APC: 1.75, p < 0.000001), then significant surge from 2016 to 2020 (APC: 5.88, p < 0.000001). Men had higher AAMRs than Women (83.8 vs 46.6), with a more pronounced increase in men (AAPC: 3.44, p < 0.000001) compared to women (AAPC: 1.23, p < 0.000001). Racially, White population had the highest AAMRs (67.1), followed by American Indians or Alaska Natives (41.9), Hispanics (33.7), Blacks (32.2), and Asians (28.1). All racial groups saw significant increases in AAMRs, most notably among American Indians or Alaska Natives (AAPC: 4.64). Geographically, AAMRs varied, with Rhode Island having the highest (103.5) and Nevada the lowest (29.7). The Midwest had the highest regional AAMR (65.1), while nonmetropolitan areas exhibited higher AAMRs than metropolitan areas, both showing overall increase throughout study (3.34 vs 2.23). Conclusion: This analysis reveals increasing trends and demographic disparities in mortality rates due to AF in CAD patients among older adults in the U.S. The recent surge in mortality rates highlights the need for targeted interventions to address these disparities and improve health outcomes for this vulnerable population.