Comparison of excess mortality between atrial fibrillation, heart failure, myocardial infarction, and stroke: trends over 2000-2022.

Background and aims: Monitoring trends in mortality of atrial fibrillation (AF) in comparison with other major cardiovascular conditions indirectly gives insights into the relative progress in management. We examined trends in relative survival metrics of AF compared with heart failure (HF), myocardial infarction (MI), and stroke.

Methods: This nationwide cohort study included all individuals newly diagnosed with AF, HF, MI, or stroke between 2000-2021. Relative survival and excess mortality rates were examined at 1, 5, and 10 years after diagnosis. The general Danish population served as the comparator, adjusted for age, sex, and calendar year.

Results: The study included 364,199 patients with AF, 242,570 with HF, 172,552 with MI, and 281,407 with stroke. For relative survival, AF had the smallest average improvement over calendar years at 1 and 5 years after diagnosis (0.35% and 0.58% per year), while at 10 years, AF, MI, and stroke had the smallest average improvements (0.77%, 0.72%, and 0.80% per year). For excess mortality rate, AF and stroke had the smallest average improvements over calendar years at 1 year (-1.02 and -0.96 additional deaths per 1000 person-years per year) and MI at 5 years (-0.13 additional deaths per 1000 person-years per year). No average improvement was observed in the 10-year excess mortality rate for MI.

Conclusions: AF was the condition or was among those with the smallest improvement in relative survival and AF and stroke showed the smallest improvement in 1-year excess mortality. The findings highlight the need for renewed efforts in prevention, early detection, and post-acute care for these conditions.