S3074 Temporal Trends in Vascular Catastrophe: Acute Mesenteric Ischemia and Atrial Fibrillation in Older Americans (1999-2023)

Introduction: Acute Mesenteric Ischemia (AMI) is a life-threatening abdominal vascular emergency frequently associated with cardiovascular conditions such as atrial fibrillation (AF). Sharing several common risk factors, AMI and AF may mutually worsen clinical outcomes when coexisting. This study analyzes nationwide mortality trends and patterns over the past 2 decades to explore the relationship between these conditions among older adults in the United States. Methods: We analyzed Centers for Disease Control and Prevention WONDER data to calculate age-adjusted and crude mortality rates per 100,000 for adults aged ≥65 who died from acute mesenteric ischemia (K55.0) and atrial fibrillation (I48). Trends were evaluated using Joinpoint regression to estimate APC and AAPC with 95% confidence intervals. Results: According to our study, from 1999 to 2023, 8,849 AMI deaths occurred in AF patients. Age-adjusted mortality declined from 1.61 to 0.68 per 100,000 (AAPC −3.39%), with a nonsignificant rise after 2020 (APC +6.61%). Female mortality was higher but declined more rapidly. Non-Hispanic Black mortality rose (AAPC +12.32%), while non-Hispanic White mortality declined. The South and Northeast saw the largest drops. Rural rates stayed higher despite sharper urban declines. Adults aged 75–84 bore the highest burden; 8034 (91%) of deaths occurred in medical facilities. Conclusion: These findings demonstrate a sustained decline in AMI mortality among AF patients, likely reflecting advances in evidence-based treatments and risk-factor control. The modest post-2020 rebound aligns with pandemic-related healthcare disruptions. Despite overall declines, female patients had a higher initial mortality but greater declines, suggesting narrowing sex gaps, possibly due to increased awareness and targeted interventions for women. Rising mortality among non-Hispanic Blacks, in contrast to declines in Whites, highlights persistent racial inequities in care and outcomes. Geographically, the largest improvements were in the South and Northeast, whereas persistently higher rates in rural areas (despite larger urban declines) underscore access gaps. Adults aged 75–84 bore the highest burden, and >90% of deaths occurred in medical facilities, emphasizing the need for age-focused strategies and robust hospital care pathways. Ongoing surveillance and targeted interventions are warranted to address remaining inequities.