{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T19:49:59Z","timestamp":1791575399322,"version":"4.3.4"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"41","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10,9]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Non-Rheumatic valvular heart disease (NRVHD) and atrial fibrillation (AF) are major contributors to cardiovascular mortality in the U.S. Their coexistence increases the risk of stroke, heart failure, and death.This study examines national trends in deaths involving both NRVHD and AF in the United States from 1999 to 2023. Centers for disease control and prevention - Wide-Ranging Online Data for Epidemiologic Research data (1999\u20132023) were analyzed for adults with AF (I48) and NRVHD (I34\u2013I36) as contributing causes of death. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population. Joinpoint regression analysis was used to determine average and annual percent change (AAPC) and annual percent change. From 1999 to 2023, a total of 141,846 deaths in the U.S. involved both AF and NRVHD. The AAMR increased from 2.98 in 1999 to 7.30 in 2023 (AAPC: 4.17;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2005&lt;\u2005.001). Males had higher overall AAMR (5.31) (AAPC: 4.73) than females (4.02) (AAPC: 3.58). Non-hispanic Whites had the highest overall AAMR (5.17) while Hispanics had an AAMR of (1.88). Regionally, West had the highest overall AAMR (5.73), followed by the Northeast (4.81), the Midwest (4.79), and then the South (3.48). Majority of the deaths occurred in inpatient medical facilities (49,170 deaths, 35.0%). The age group 65\u2005+\u2005showed the highest mortality (crude mortality rate: 11.93). Rural areas had higher overall AAMR (4.36) compared to urban areas (4.10). Deaths involving both AF and NRVHD increased from 1999 to 2023, with greater burden among older adults, males, rural areas, the West region, and non-Hispanic White population.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/md.0000000000051020","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T19:00:30Z","timestamp":1791572430000},"page":"e51020","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Mortality involving non-rheumatic valvular heart disease and atrial fibrillation in the United States"],"prefix":"10.1097","volume":"105","author":[{"given":"Ibtissam","family":"ElGhazzani","sequence":"first","affiliation":[{"name":"Faculty of Medicine of Tunis, Tunis, Tunisia"},{"name":"Cardiovascular Research Group, Fawzi Research Network, Alexandria, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youssef","family":"Ramadan","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Group, Fawzi Research Network, Alexandria, Egypt"},{"name":"Faculty of Medicine, October 6 University, Giza, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyaa","family":"Ahmed Ibrahim","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Group, Fawzi Research Network, Alexandria, Egypt"},{"name":"Faculty of Medicine, Alexandria University, Alexandria, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Saghir","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Sarim","family":"Azad Khan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Combined Military Hospital, Lahore Medical College, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim Othman","family":"Abdelnaim","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Group, Fawzi Research Network, Alexandria, Egypt"},{"name":"Faculty of Medicine, Ain Shams University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moustafa Ahmed","family":"Elsayed","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Group, Fawzi Research Network, Alexandria, Egypt"},{"name":"Faculty of Medicine, Tanta University, Tanta, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul","family":"Samad","sequence":"additional","affiliation":[{"name":"Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr","family":"Arafa","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Group, Fawzi Research Network, Alexandria, Egypt"},{"name":"Faculty of Medicine, Alexandria University, Alexandria, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krish","family":"Patel","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Group, Fawzi Research Network, Alexandria, Egypt"},{"name":"Department of Medicine, C. U. Shah Medical College, Surendranagar, Gujarat, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eshal","family":"Saghir","sequence":"additional","affiliation":[{"name":"Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.N.U.","family":"Sahil","sequence":"additional","affiliation":[{"name":"Department of Medicine, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maha","family":"Sajjad","sequence":"additional","affiliation":[{"name":"Department of Medicine, King Edward Medical University, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4872-5603","authenticated-orcid":false,"given":"Yahya","family":"Samadi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Kateb University, Kabul, 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