Emerging trends and disparities in mortality due to coexisting atrial fibrillation and sepsis: A US nationwide observational study (1999–2023)

Sepsis patients are highly susceptible to atrial fibrillation (AF) and atrial flutter due to the proinflammatory and adrenergic milieu, which precipitates arrhythmogenesis, especially in vulnerable individuals. Understanding mortality trends and disparities in this population is essential for targeted interventions. We analyzed US death certificates from the Center of Disease Control Wide-Ranging Online Data for Epidemiologic Research database for individuals aged ≥25 years who died between 1999 and 2023 with both sepsis and AF listed as causes. We calculated age-adjusted mortality rates (AAMRs), which measure changes in death rates over time while accounting for differences in age distribution, and annual percent change to evaluate yearly trends in these rates across demographic groups stratified by year, sex, age group, race/ethnicity, geographic region, and urbanization status. A total of 2,40,222 deaths involved both AF/atrial flutter and sepsis. The overall AAMR increased from 2.0 per 1,00,000 in 1999 to a peak of 7.9 in 2021 (annual percent change +5.6% through 2018, accelerating to +12.6% through 2021), with a slight decline to 7.1 by 2023. Mortality was consistently higher in men than women, older adults, residents of nonmetropolitan areas, and the US South. By race/ethnicity, non-Hispanic White and Black individuals had the highest AAMRs, followed by American Indian/Alaska Native, Hispanic, and Asian/Pacific Islander populations. Deaths involving AF and sepsis have risen substantially over the past 4 decades, with sharp increases in recent years and persistent disparities by age, sex, race/ethnicity, and geography. These findings underscore the need for integrated arrhythmia-sepsis management strategies, enhanced access to critical care in underserved regions, and equity-focused public health interventions to mitigate mortality.