SUN-658 - Trends and Disparities in Atrial Fibrillation and Heart Failure Mortality in United States Adults 45 Years and Older with Diabetes, 1999-2023, with Projections to 2035.

Background:
Atrial fibrillation (AFib) and heart failure (HF) frequently co-occur in adults with DM and represent an important clinical and public health concern. We quantified long-term trends and sociodemographic and geographic disparities in AF and HF associated mortality among U.S. adults ≥45 years with DM listed as the underlying cause of death and generated projections through 2035

Methods:
We analyzed publicly available, de-identified CDC WONDER mortality data (1999–2023) for adults ≥45 years, stratified by sex, race/ethnicity, and urbanization. AFib and HF were identified using ICD-10 codes I48 and I50, respectively. ICD-10 codes E10-14 were used to identify DM as the underlying cause of death (UCD). Age-adjusted mortality rates (AAMRs) per 1,000,000 were calculated, and trends were analyzed. Join-point regression was used to calculate annual percentage changes (APCs) with 95 % confidence intervals (CIs). Future mortality rates were forecasted using an optimal Autoregressive Integrated Moving Average (ARIMA) model.

Results:
A total of 34,901 deaths were attributed to AFib and HF among patients with underlying DM. The AAMR per 1,000,000 inclined from 5.0 in 1999 to 19.34 in 2023 with an overall AAPC value of 5.38 (95% CI: 4.88 to 6.38; p value: < 0.001). From 1999-2023, both sexes showed an incline with males having higher AAMRs (4.96-25.73) than females (4.90-14.40). In 2023, Non-Hispanic (NH) Black or NH African American population had the highest AAMR (21.79), followed by NH White population (19.7) and Hispanic Latino communities (17.23). The Midwest had the highest AAMR (23.4) in 2023, followed by the South (19.59), the West (19.13), and the Northeast (14.22). Nonmetropolitan areas had higher overall AAMR (12.24) than metropolitan areas (9.30). Among states, the highest AAMRs was in the Louisiana state (34.43) and the lowest was in Connecticut (9.03). ARIMA projections suggested declining AAMR from 18.93 (2024) to 15.51 (2035) with an overall AAPC value of 3.34 (95% CI: 3.26 to 3.37).

Conclusion:
AFib- and HF associated mortality among U.S. adults ≥45 years with diabetes mellitus (DM) as the underlying cause of death increased over the study period, with higher rates in males, non-Hispanic Black/African American individuals, and non-metropolitan areas. The Midwest and the South had the highest burden. Although projections suggest declining rates through 2035, persistent disparities highlight the need for targeted interventions to improve equitable access to care.

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