Trends in age- and sex-specific atrial fibrillation/flutter mortality in Italy between 2003 and 2017

Abstract

Aims: We sought to assess the atrial fibrillation/flutter (AF/AFL) mortality rates and relative trends among the Italian population between 2003 and 2017.

Methods: Data regarding the cause-specific mortality and population size by sex in 5-year age groups were extracted from the World Health Organization (WHO) global mortality database. Decedents reporting the codes I48 were extracted accordingly to the International Classification of Disease-10 (ICD-10) coding system. The age-adjusted mortality rates (AAMRs), with relative 95% confidence intervals (CIs), also stratified by sex, were determined using the direct method. Joinpoint regression analyses were used to identify periods with statistically distinct log linear trends in AF/AFL-related death rates. To calculate nationwide annual trends in AF/AFL-related mortality, we assessed the average annual percentage change (AAPC) and relative 95% CIs.

Results: Over the study period, 90 623 (57 109 females) AF-related deaths were recorded. The AF/AFL AAMR increased from 8.1 (95% CI: 7.8-8.2) deaths per 100 000 to 18.7 (16.9-20.0) deaths per 100 000 population. Joinpoint regression analysis revealed a linear increase in age-standardized AF/AFL-related mortality [AAPC: +3.6 (95% CI: 3.0-4.3, P < 0.0001)] in the entire Italian population. Moreover, the mortality rate increased with age, showing a seemingly exponential distribution with a similar trend between males and females. Although the increase was more pronounced among women [AAPC: +3.7 (95% CI: 3.1-4.3, P < 0.0001)] compared with men [AAPC: +3.4 (95% CI: 2.8-4.0, P < 0.0001)], the difference did not reach statistical significance ( P = 0.16).

Conclusions: In Italy, the AF/AFL-related mortality rates linearly increased from 2003 to 2017.