Rising cardiovascular mortality among older adults with coexisting cancer and atrial fibrillation: A 25-year u.S. analysis (1999–2024).

Abstract Background: Cardiovascular diseases (CVDs) remain the leading cause of mortality in the United States. Older adults with comorbid cancer and atrial fibrillation (AF) face an elevated risk of adverse cardiovascular outcomes. This study evaluates trends in cardiovascular mortality among adults aged 65 and above with cancer and AF as contributing causes of death. Methods: Data were obtained from the CDC WONDER Multiple Cause of Death database for the years 1999–2024. Adults aged ≥65 years with CVDs listed as the underlying cause of death and both cancer and AF as contributing causes were included. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 U.S. population. Joinpoint regression assessed temporal trends using annual percent change (APC). Results: A total of 86,660 deaths were recorded. The AAMR increased from 5.8 in 1999 to 11.0 in 2024, with a significant rise observed after 2011 (APC: 2.37%), and a sharp acceleration between 2017 and 2022 (APC: 7.62%). Males had a higher AAMR (11.0) compared to females (5.3). Non-Hispanic Whites (8.0) experienced the highest AAMR among racial groups. AAMRs were greater in non-metropolitan areas (7.7) than metropolitan areas (6.8), with the West region reporting the highest burden (8.6). Conclusions: Cardiovascular mortality among older adults with coexisting cancer and AF has more than doubled since 1999, with sharp increases in recent years. These findings highlight the growing impact of multimorbidity in aging populations and the urgent need for integrated cardiology-oncology care approaches.