AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Stroke-Related Mortality Associated with Atrial Fibrillation: Rising Burden, Recent Declines, and Persistent Disparities in the United States, 1999-2024
By Shah SU, Amin Z, Naufil SI et al.
Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is a major risk factor for ischemic stroke, contributing substantially to stroke-related disability and mortality in the United States. Despite advances in anticoagulation therapy and stroke prevention strategies, the long-term population-level burden of stroke-related mortality among individuals with AF remains incompletely characterized. Evaluating temporal trends and disparities may identify vulnerable populations and inform targeted prevention efforts. Research Question: How have stroke-related mortality rates among U.S. adults with atrial fibrillation changed over time, and do these trends differ by sex, age, race/ethnicity, and geographic location? Methods We analyzed CDC WONDER mortality data from 1999-2024 for U.S. adults aged ≥25 years with stroke (ICD-10: I60-I69) and AF (ICD-10: I48) listed on death certificates. Age-adjusted mortality rates (AAMRs) were stratified by sex, age group, race/ethnicity, census region, and urbanization status. Temporal trends were assessed using Joinpoint regression and annual percent changes (APCs). Statistical significance was defined as p<0.05. Results: A total of 713,308 stroke-related deaths associated with AF were identified. Overall mortality declined from 1999-2008 (APC, –0.52%, p>0.05), increased from 2008-2018 (APC, 1.37%, p<0.05), rose from 2018-2021 (APC, 6.93%, p<0.05), and declined from 2021-2024 (APC, –2.63%, p<0.05). Men had higher mortality than women (AAMR: 12.3 vs. 11.7 per 100,000). Among men, mortality increased from 2008-2018 (APC, 2.10%, p<0.05) and 2018-2021 (APC, 9.16%, p<0.05), then declined from 2021-2024 (APC, –2.79%, p<0.05). Among women, mortality increased from 2007-2018 (APC, 0.75%, p<0.05) and 2018-2021 (APC, 5.36%, p<0.05), followed by a decline. Mortality was highest among older adults. White individuals had the highest AAMRs, followed by Black/African American, Asian/Pacific Islander, Hispanic, and American Indian/Alaska Native populations. Mortality was also higher in non-metropolitan areas and the Western census region. Conclusions: Stroke-related mortality associated with AF increased for more than a decade before declining after 2021, highlighting persistent opportunities for improved prevention and management. Men, older adults, and residents of non-metropolitan regions experienced a disproportionate mortality burden. These findings underscore the need for enhanced AF detection, equitable access to evidence-based anticoagulation, and targeted stroke prevention strategies to reduce ongoing demographic and geographic disparities.