National Mortality Trends, Disparities, and Forecasted Burden of Atrial Fibrillation and Heart Failure with Underlying Ischemic Heart Disease Among Older Adults in the United States, 1999–2023

Atrial fibrillation (AF) and congestive heart failure (CHF) remain major contributors to cardiovascular mortality in the United States. When accompanied by underlying ischemic heart disease (IHD), mortality risk is amplified. Although IHD mortality declined in the early 2000s, recent data suggest a resurgence. This population-based study used the CDC Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database from 1999 to 2023. Deaths were identified using ICD-10 codes I48 (AF) and I50.0 (CHF) as multiple causes of death and I20–I25 (IHD) as the underlying cause. Adults aged ≥ 65 years were included. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) were calculated. Temporal trends were analyzed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Future mortality trends were projected using autoregressive integrated moving average (ARIMA) model. From 1999 to 2023, AF, CHF, and IHD accounted for 219,188 deaths among adults ≥ 65 years. The overall AAMR increased from 193.8 per million in 1999 to 220.1 per million in 2023, with a decline from 1999 to 2010 followed by a sustained rise. Males (108,732 deaths) showed the steepest increase (AAPC + 1.40%, p < 0.001), whereas females (110,456 deaths) experienced a modest decline (AAPC − 0.55%, p < 0.001). Non-Hispanic Black adults had the largest racial increase (AAPC + 1.21%, p < 0.001). Non-metropolitan areas showed the greatest geographic rise (AAPC + 1.67%, p < 0.001). Mortality involving AF and CHF with underlying IHD among U.S. adults ≥ 65 years declined only temporarily before reversing after 2010. Persistent racial and geographic disparities underscore gaps in prevention and acute cardiovascular care. Not applicable.