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Intracerebral hemorrhage mortality in individuals with atrial fibrillation: a nationwide analysis of mortality trends in the United States

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Abstract

Background

Atrial fibrillation (AF) is a risk factor for intracerebral hemorrhage (ICH), both with and without use of anticoagulation. Limited data exists on mortality trends and disparities related to this phenomenon. We aimed to assess ICH mortality trends and disparities based on demographic factors in individuals with atrial fibrillation in the United States (US).

Methods

Our cross-sectional analysis utilized mortality data from the CDC database through death certificate queries from the years 1999 to 2020 in the US. We queried for all deaths with ICH as the underlying cause of death and atrial fibrillation as the multiple causes of death. Mortality data was obtained for overall population and demographic subpopulations based on sex, race and ethnicity, and geographic region. Trend analysis and average annual-mortality percentage change (AAPC) were completed using log-linear regression models.

Results

ICH age-adjusted mortality rate (AAMR) in patients with AF increased from 0.27 (95% CI 0.25–0.29) in 1999 to 0.30 (95% CI 0.29–0.32) in 2020. A higher mortality rate was observed in males (AAMR 0.33) than in females (AAMR 0.26). The highest mortality was found in Asian/Pacific Islander (AAMR: 0.32) populations, followed by White (AAMR: 0.30), Black (AAMR: 0.15), and American Indian/Alaska Native (AAMR: 0.11) populations. Southern (AAPC: 1.3%) and non-metropolitan US regions (AAPC: + 1.9%) had the highest increase in annual mortality change.

Conclusion

Our findings highlight the disparities in ICH mortality in patients with AF. Further investigation is warranted to confirm these findings and evaluate for contributors to the observed disparities.

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Data availability

All data are available in publicly available repositories.

Abbreviations

AAMR:

Age-adjusted mortality rate

AAPC:

Average annual percentage change

CDC:

Centers for Disease Control and Prevention

ICD-10:

International Classification of Diseases, 10th revision

ICH:

Intracerebral hemorrhage

US:

United States

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Acknowledgements

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Authors and Affiliations

  1. Department of Medicine, University of Arizona Tucson, Tucson, Arizona, USA

    Hoang Nhat Pham, Enkhtsogt Sainbayar & Ramzi Ibrahim

  2. Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue J2-2, Cleveland, Ohio, USA

    Justin Z. Lee

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Correspondence to Justin Z. Lee.

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Pham, H.N., Sainbayar, E., Ibrahim, R. et al. Intracerebral hemorrhage mortality in individuals with atrial fibrillation: a nationwide analysis of mortality trends in the United States. J Interv Card Electrophysiol (2023). https://doi.org/10.1007/s10840-023-01674-x

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