Divergent Temporal Trends in Morbidity and Mortality Related to Heart Failure and Atrial Fibrillation: Age, Sex, Race, and Geographic Differences in the United States, 1991–2015

Background: Heart failure (HF) and atrial fibrillation (AF) are rising in prevalence and pose a substantial public health burden. Methods and Results: We evaluated temporal trends specific to age, sex, race, and geographic region in rates of HF- and AF-related morbidity, mortality, and years of potential life lost at age 75 years between 1991 and 2015 in the United States. For trends in hospitalization with a primary diagnosis of HF versus AF, we used data for patients aged ≥30 years from 1993 to 2014 from the Nationwide Inpatient Sample. For trends in death due to HF versus AF, we used data from 1991 to 2015 from the National Center for Health Statistics. Over the past 25 years, the age-adjusted rates of hospitalization declined for HF (−1.72% per year) but increased for AF (+1.61% per year). HF mortality rates remained unchanged, whereas those for AF increased (+11.2% per year). Years of potential life lost increased for both HF (+0.4% per year) and AF (+9.8% per year). Trends in HF and AF morbidity rates varied moderately by age group, whereas mortality rates varied by age and race. HF and AF hospitalization and mortality rates rose for individuals aged <50 years. HF hospitalization rates declined in all 4 US census regions, whereas AF rates increased. Conclusions: We observed divergent trends of decreasing hospitalization and mortality rates for HF versus increasing rates for AF. Variations in disease burden by race and geography warrant specific targeting of “at risk” groups in selected US regions. Additional studies are warranted to evaluate the rising burden of both conditions in younger adults.