The Rising Burden of Atrial Fibrillation and Respiratory Failure Mortality in the United States: A 25‐Year Nationwide Retrospective Analysis of Death Certificate Data

ABSTRACT 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.