{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:56:20Z","timestamp":1791384980289,"version":"4.3.3"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Atrial fibrillation (AF) prevalence has risen alongside an aging US population and wider adoption of contemporary therapies, yet population\u2010level changes in mechanisms of death among people with AF remain incompletely characterized. We used National Death Certificate Trends in AF Mortality data to assess 25\u2010year trends in AF\u2010related mortality and the contribution of heart failure (HF), stroke, myocardial infarction (MI), and dementia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis of CDC WONDER records for US decedents aged \u2265\u200935 years with AF listed as a contributing cause of death from 1999 to 2023, coinciding with the implementation of ICD\u201010 coding in the CDC database. We quantified all\u2010cause and cause\u2010specific mortality rates per 100\u2009000 and stratified trends by age, sex, and race. The analytic cohort included decedents with AF and at least one of four cardiovascular conditions (stroke, dementia, HF, or MI) listed as a primary or contributing cause of death. Confidence intervals were obtained from CDC WONDER outputs or calculated per CDC guidance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3\u2009273\u2009015 decedents with AF noted on the death certificate, 461\u2009321 had HF, dementia, stroke, or MI listed as a contributing cause. HF emerged as the leading cause\/contributor with a steep rise beginning in approximately 2008. Stroke rates were stable or declining, MI\u2010related mortality remained low and stable, while dementia, particularly stroke\u2010free dementia, increased significantly in adults \u2265\u200985 (outpacing stroke among the oldest White decedents since early 2000s). Non\u2010White groups exhibited higher stroke and HF mortality trends; women \u2265\u200985 had higher stroke\u2010related mortality than men.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Over 25 years, AF\u2010associated mortality patterns shifted toward HF and stroke\u2010free dementia while ischemic stroke and MI declined or stabilized. Findings highlight the need to expand AF care beyond stroke prevention to prioritize HF prevention\/management, cognitive health, equitable AF\u2010care pathways to ensure broad access to therapies, and additional studies of targeted interventions to mitigate disease risks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jce.70524","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:19:56Z","timestamp":1791382796000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evolving Mechanisms on Mortality in Atrial Fibrillation: A 25\u2010Year National Death\u2010Certificate Analysis"],"prefix":"10.1111","author":[{"given":"Jacqueline S.","family":"Dickey","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine, University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Goodwin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine, University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bobby","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine, University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2363-2426","authenticated-orcid":false,"given":"Arthur","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine, University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc C.","family":"Engels","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine, University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2070-3958","authenticated-orcid":false,"given":"Klitos","family":"Konstantinidis","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine, University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4379-283X","authenticated-orcid":false,"given":"Immo","family":"Lehmann","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine, University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Roberto","family":"Martinez\u2010Parachini","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine, University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas L.","family":"Packer","sequence":"additional","affiliation":[{"name":"Intermountain Medical Center Intermountain Health Murray Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3321-2435","authenticated-orcid":false,"given":"Ravi","family":"Ranjan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine, University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4729-7820","authenticated-orcid":false,"given":"Benjamin A.","family":"Steinberg","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Cardiovascular Medicine University of Colorado Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5349-0136","authenticated-orcid":false,"given":"T.","family":"Jared Bunch","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine, University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1016\/j.jacc.2024.07.014","article-title":"Minimum National Prevalence of Diagnosed Atrial Fibrillation Inferred From California Acute Care Facilities","volume":"84","author":"Noubiap J. J.","year":"2024","journal-title":"Journal of the American College of Cardiology"},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1186\/s12872-025-05036-5","article-title":"Trends in United States Mortality Among Patients With Atrial Fibrillation\/Flutter Related Heart Failure (1999\u20102024): Disparities by Gender, Race\/Ethnicity and Region","volume":"25","author":"Rani S.","year":"2025","journal-title":"BMC Cardiovascular Disorders"},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"1932","DOI":"10.1016\/j.jacc.2022.03.337","article-title":"The Increasing Role of Rhythm Control in Patients With Atrial Fibrillation","volume":"79","author":"Camm A. J.","year":"2022","journal-title":"Journal of the American College of Cardiology"},{"key":"e_1_2_8_5_1","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.122.026723","article-title":"Trends in Oral Anticoagulant Use Among 436 864 Patients With Atrial Fibrillation in Community Practice, 2011 to 2020","volume":"11","author":"Navar A. M.","year":"2022","journal-title":"Journal of the American Heart Association"},{"key":"e_1_2_8_6_1","article-title":"Improving Heart Failure Quality of Care Over the First Twenty Years: The Get With The Guidelines\u2010Heart Failure Program","volume":"19","author":"Tang A. B.","year":"2026","journal-title":"Circulation: Heart Failure"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwaf371"},{"key":"e_1_2_8_8_1","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1161\/CIR.0000000000001193","article-title":"2023 ACC\/AHA\/ACCP\/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"149","author":"Joglar J. A.","year":"2024","journal-title":"Circulation"},{"key":"e_1_2_8_9_1","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration With the European Association for Cardio\u2010Thoracic Surgery (EACTS)","volume":"45","author":"Van Gelder I. C.","year":"2024","journal-title":"European Heart Journal"},{"key":"e_1_2_8_10_1","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1016\/j.jacc.2023.12.033","article-title":"Implications of Atrial Fibrillation for Guideline\u2010Directed Therapy in Patients With Heart Failure","volume":"83","author":"Newman J. D.","year":"2024","journal-title":"Journal of the American College of Cardiology"},{"key":"e_1_2_8_11_1","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.125.046643","article-title":"Patterns of Adherence and Persistence to Triple and Quadruple Guideline\u2010Directed Medical Therapy Among US Patients With Heart Failure With Reduced Ejection Fraction","volume":"15","author":"Fonarow G. C.","year":"2026","journal-title":"Journal of the American Heart Association"},{"key":"e_1_2_8_12_1","doi-asserted-by":"crossref","first-page":"2716","DOI":"10.1002\/ejhf.70090","article-title":"Adherence to Guideline\u2010Directed Medical Treatments in Heart Failure. A Scientific Statement of the Heart Failure Association (HFA) of the ESC and the ESC Working Group on Cardiovascular Pharmacotherapy","volume":"27","author":"Savarese G.","year":"2025","journal-title":"European Journal of Heart Failure"},{"key":"e_1_2_8_13_1","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1111\/j.1540-8167.2011.02035.x","article-title":"Patients Treated With Catheter Ablation for Atrial Fibrillation Have Long\u2010Term Rates of Death, Stroke, and Dementia Similar to Patients Without Atrial Fibrillation","volume":"22","author":"Bunch T. J.","year":"2011","journal-title":"Journal of Cardiovascular Electrophysiology"},{"key":"e_1_2_8_14_1","article-title":"Prognostic Impact of Sinus Rhythm in Atrial Fibrillation Patients: Separating Rhythm Outcomes From Randomized Strategy Findings From the CABANA Trial","volume":"17","author":"Bunch T. J.","year":"2024","journal-title":"Circulation: Arrhythmia and Electrophysiology"},{"key":"e_1_2_8_15_1","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1001\/jama.2019.0693","article-title":"Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial","volume":"321","author":"Packer D. L.","year":"2019","journal-title":"Journal of the American Medical Association"},{"key":"e_1_2_8_16_1","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1056\/NEJMoa2019422","article-title":"Early Rhythm\u2010Control Therapy in Patients With Atrial Fibrillation","volume":"383","author":"Kirchhof P.","year":"2020","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_8_17_1","article-title":"Incidence, Prevalence and Trends in Mortality and Stroke Among Medicare Beneficiaries With Atrial Fibrillation: 2013\u20102019","author":"Rogovoy N. M.","year":"2025","journal-title":"Circulation: Cardiovascular Quality and Outcomes"},{"key":"e_1_2_8_18_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0209687","article-title":"Mortality and Causes of Death in Patients With Atrial Fibrillation: A Nationwide Population\u2010Based Study","volume":"13","author":"Lee E.","year":"2018","journal-title":"PLoS One"},{"key":"e_1_2_8_19_1","doi-asserted-by":"crossref","first-page":"e544","DOI":"10.1016\/j.hrthm.2025.04.001","article-title":"Criteria for the Establishment of an Atrial Fibrillation Center of Excellence and Key Operational Standards","volume":"22","author":"Jared Bunch T.","year":"2025","journal-title":"Heart Rhythm: The Official Journal of the Heart Rhythm Society"},{"key":"e_1_2_8_20_1","doi-asserted-by":"crossref","first-page":"2578","DOI":"10.1002\/ehf2.14911","article-title":"Optimizing Heart Failure Pathways to Enhance Patient Care: The Program to Optimize Heart Failure Patient Pathways (PRO\u2010HF)","volume":"11","author":"Patwala A.","year":"2024","journal-title":"ESC Heart Failure"},{"key":"e_1_2_8_21_1","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.119.013154","article-title":"Sex Differences in Cardiovascular Disease and Cognitive Impairment: Another Health Disparity for Women?","volume":"8","author":"Volgman A. S.","year":"2019","journal-title":"Journal of the American Heart Association"},{"key":"e_1_2_8_22_1","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.tcm.2023.01.005","article-title":"Atrial Fibrillation and the Risk of Early\u2010Onset Dementia and Cognitive Decline: An Updated Review","volume":"34","author":"Kogelschatz B.","year":"2024","journal-title":"Trends in Cardiovascular Medicine"},{"key":"e_1_2_8_23_1","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.125.046111","article-title":"Patient Care Pathways and Outcomes Following Newly Diagnosed Atrial Fibrillation","volume":"15","author":"Zeitler E. P.","year":"2026","journal-title":"Journal of the American Heart Association"}],"container-title":["Journal of Cardiovascular Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.70524","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jce.70524","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.70524","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:19:59Z","timestamp":1791382799000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jce.70524"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":22,"alternative-id":["10.1111\/jce.70524"],"URL":"https:\/\/doi.org\/10.1111\/jce.70524","archive":["Portico"],"relation":{},"ISSN":["1045-3873","1540-8167"],"issn-type":[{"value":"1045-3873","type":"print"},{"value":"1540-8167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"assertion":[{"value":"2026-06-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jce.70524"}}