ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. General Cardiovascular Medicine
Temporal Trends in Mortality Involving Atrial Fibrillation and Rheumatic Heart Disease: A 25-Year Nationwide Analysis
Provisionally accepted
Mohamed Fawzi Hemida1
Maryam Saghir2
Alyaa Ahmed Ibrahim1Anika Goel3
Amna Amir Jalal2
Krish Patel4Eshal Saghir5
Mirna Hussein1Abdrabo Gamal6
Mustafa Alsaadi7
Maha Sajjad8Mahmoud Tablawy9
Omar Alkasabrah10
Mohammed Hammad Jaber Amin11*- 1Alexandria University Faculty of Medicine, Alexandria, Egypt
- 2Jinnah Sindh Medical University, Karachi, Pakistan
- 3Kakatiya Medical College, Warangal, India
- 4CU Shah Medical College, Surendranagar, India
- 5Dow University of Health Sciences, Karachi, Pakistan
- 6Menoufia University Faculty of Medicine, Shebeen El-Kom, Egypt
- 7Jabir ibn Hayyan Medical University, Kufa, Iraq
- 8King Edward Medical University, Lahore, Pakistan
- 9Al-Azhar Faculty of Medicine New Damietta, Dumyat al Jadidah, Egypt
- 10New York Medical College/ Landmark Medical Center, Woonsocket, Rhode Island, New York, United States
- 11Al Zaiem Al Azhari University, Khartoum, Sudan
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Background: Atrial fibrillation (AF) and rheumatic heart disease (RHD) can coexist with potential for serious complications. Trends involving both conditions remain unexplored and this study aims to explore them. Methods: Nationwide mortality records were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER) database from 1999–2023 among U.S. adults > 45 years with AF (ICD-10 code: I48) and RHD (I05-I09). Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population and stratified by demographic variables. Joinpoint regression analysis was used to determine the average and annual percent change (AAPC and APC). Results: From 1999 to 2023, a total of 36,701 deaths were reported among individuals aged >45 years with AF and RHD in the U.S. The AAMR increased from 1.04 in 1999 to 2.00 in 2023 (AAPC: 2.78; p=0.001). Women had higher overall AAMR (1.34) (AAPC:2.48; p< 0.001) than men (1.06) (AAPC:4.14; p<0.001). Racially, the highest overall AAMR was in Non-Hispanic (NH) White (1.32) while the overall AAMR in Hispanics was (0.73). Regionally, the highest overall AAMR was noticed in the West (1.68), followed by the Midwest (1.36). The majority of deaths occurred in inpatient medical facilities (13,939 deaths, 38%). Rural areas had higher overall AAMR (1.2) compared to urban areas (1.1). Conclusion: Trends in AF and RHD mortality increased lately. Higher trends observed in women, rural areas, the West region, NH white population and inpatient medical facilities.
Keywords: Atrial Fibrillation, Rheumatic Heart Disease, Trends, Mortality, Joinpoint regression analysis
Received: 17 Aug 2025; Accepted: 21 Nov 2025.
Copyright: © 2025 Fawzi Hemida, Saghir, Ahmed Ibrahim, Goel, Amir Jalal, Patel, Saghir, Hussein, Gamal, Alsaadi, Sajjad, Tablawy, Alkasabrah and Jaber Amin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mohammed Hammad Jaber Amin, mohammesjaber123@gmail.com
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