Trends in atrial fibrillation/atrial flutter and cirrhosis-related mortality in the United States from 1999 to 2020: a CDC WONDER analysis

Background: Atrial fibrillation/atrial flutter (AF/AFL) and cirrhosis have emerged as significant contributors to mortality in the United States (U.S.). This retrospective study investigates the trends associated with the coexistence of AF/AFL and mortality related to cirrhosis in adults between 1999 and 2020. Methods: To study mortality trends related to AF/AFL and cirrhosis, the CDC WONDER (Wide-Ranging Online Data for Epidemiological Research) database was used. Mortality rates were examined using both crude mortality rates (CMR) and age-adjusted mortality rates (AAMR). To evaluate mortality trends, Joinpoint regression analysis was applied, allowing us to determine annual percentage change (APC), average annual percentage change (AAPC), and statistical significance ( P < 0.05). Results: Mortality due to AF/AFL and Cirrhosis from 1999 to 2020 reached a total of 32 461 deaths, with the AAMR increasing from 4.43/1 000 000 deaths in 1999 to 18.48/1 000 000 deaths in 2020. This trend demonstrates a significant increase in mortality over the study period, with the largest proportion of deaths occurring in a hospital facility-inpatient (48.95%). The AAMR was highest among males (12.33), older adults aged 85 and above (CMR: 45.77), Hispanic populations (9.28), residents in the West (10.95), and those in non-metropolitan regions (9.4). Notable state-level disparities were identified, with Vermont (14.28), West Virginia (12.94), and Oregon (12.91) reporting the highest AAMRs. Although increases varied over time, the most rapid growth occurred between 2015 and 2020. Conclusions: AF/AFL and cirrhosis-related mortality surged nationwide, disproportionately affecting vulnerable groups. Escalating trends demand urgent, equity-focused strategies in prevention, diagnosis, and healthcare delivery to mitigate this critical and worsening public health threat.