Trends in Atrial Fibrillation-Related Mortality Among Older Adults With hypertension in the United States, 2001–2023

Background The coexistence of atrial fibrillation (AF) or atrial flutter (AFL) and hypertension represents a major public health challenge, particularly among older adults, due to its strong association with adverse cardiovascular outcomes and mortality. Methods We conducted a nationwide, population-based study using mortality data from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) system between 2001 and 2023. Deaths among U.S. adults aged ≥ 65 years with AF/AFL and hypertension were identified using ICD-10 codes. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) were calculated and stratified by sex, race/ethnicity, census region, and urban–rural classification. Temporal trends were assessed using Joinpoint regression analysis to estimate annual percentage change (APC) and average annual percentage change (AAPC). Results From 2001 to 2023, 77,599 AF/AFL-related deaths were attributed to concomitant hypertension, with a disproportionate burden observed among women (65%) compared to men (35%). Overall, the AAMR increased from 2.77 per 100,000 in 2001 to 12.54 in 2023 (AAPC 7.15%, p < 0.001). Women consistently exhibited higher mortality rates than men, and non-Hispanic White individuals experienced the steepest rise in AAMRs compared with non-Hispanic Black and Hispanic populations. Geographic disparities were also evident, with the Midwest and South showing the highest increases. Older adults aged ≥ 85 years demonstrated the highest mortality rates across all subgroups. Conclusions Mortality related to AF/AFL in the presence of hypertension has risen substantially in the United States over the past two decades, with notable disparities by sex, race/ethnicity, age, and region. These findings underscore the urgent need for targeted public health interventions and clinical strategies to improve risk factor control, enhance early detection, and address inequities in care among high-risk populations.