Deaths from atrial fibrillation

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Most people with AF do not die from the condition, but from accompanying comorbidities and complications such as heart failure, myocardial infarction, stroke, chronic kidney disease, dementia or cancer. The complex causal interactions between AF and its comorbidities often leads to interdependence in disease development (Kornej et al. 2020).

AF is far more likely to be listed on a death certificate as an associated cause of death rather than the underlying cause of death, and so the most complete picture of the mortality burden of AF is obtained by examining deaths in which AF is listed as either an underlying or an associated cause of death.

In 2018, AF was the underlying or associated cause of over 14,000 deaths in Australia—9.0% of total deaths.

Age and sex

In 2018, for deaths with an AF cause (underlying or associated):

  • 62% of people were aged 85 and older
  • just over half (52%) were female
  • were 1.3 times as high for males as for females (49 and 37 per 100,000 population) when the rate was age standardised
  • increased sharply with increasing age, from 17 per 100,000 population for persons aged 55–69 years, to 213 per 100,000 population for persons aged 70–84 years, to 1,736 per 100,000 population for persons aged 85 and over
  • were higher, as a rate per population, for males than females in all age groups. The difference was largest in persons aged 55–69, with the male rate 2.4 times as high as the female rate (24 and 10 per 100,000 population). The relative difference decreased with increasing age (Figure 8).

Figure 8: Atrial fibrillation death rate, underlying and associated cause, by age and sex, 2018

The column graph shows the distribution of atrial fibrillation deaths increased with age in 2018. The rate of death was considerably higher in the 85+ age group than those in younger age groups, with rates of death increasing from 260 per 100,000 in males aged 70-84 years to 1,835 per 100,000 in males aged over 85 years. Similarly, the rate of death for females increased from 171 to 1,676 per 100,000 population.

Source: AIHW National Mortality Database. (Data table 15)

Population groups

Aboriginal and Torres Strait Islander people

During the 3-year period 2016–2018, AF was a cause of death (underlying or associated) of 381 Aboriginal and Torres Strait Islander people in the 5 jurisdictions with adequate Indigenous identification. This represents a rate of 18 deaths per 100,000 population.

The death rate from AF was higher for Indigenous Australians than for non-Indigenous Australians across sex and age groups, with the exception of males aged 75 and over (Figure 9). The relative difference between Indigenous and non-Indigenous death rates was largest in younger age groups. Indigenous females aged 75 and over had a higher death rate from AF than Indigenous males, as well as both non-Indigenous males and females aged 75 and over (Figure 9). After adjusting for differences in the age structures between the populations, the rate of death among Indigenous Australians was 1.4 times as high as non-Indigenous Australians (63 and 44 per 100,000 population) (Figure 10).

Higher rates of fatal stroke among Indigenous Australians with AF have been associated with a higher prevalence of cardiovascular risk factors and vascular disease in younger age groups (Nedkoff et al. 2020).

Figure 9: Atrial fibrillation death rate, underlying and associated cause, by age, sex and Indigenous status, 2016–2018

The bar graph shows the age distribution of atrial fibrillation death rates by sex and indigenous status in 2016-18. Rates of death were higher among Indigenous Australians across all age groups except males aged 85 and over, where Non-Indigenous males had a higher rate of death at 778 per 100,000 population. Indigenous females aged 85+ years had the highest rate of death in 2016-18 at 836 deaths per 100,000 population.

Source: AIHW National Mortality Database. (Data table 20)

Remoteness and socioeconomic position

During 2016–2018, AF death rates were:

  • highest in Remote and very remote areas (53 per 100,000 population), followed by Outer regional areas, Inner regional areas and Major cities (50, 47 and 41 per 100,000 population, respectively)
  • 1.4 times as high in the lowest socioeconomic group compared with the highest socioeconomic group (51 and 36 per 100,000 population) (Figure 10).

Figure 10: Atrial fibrillation deaths rate, underlying and associated cause, by population group, 2016–2018

The bar graph shows the distribution of atrial fibrillation deaths by population group and sex in 2016-18. The rate of atrial fibrillation death was higher for males than females across all population groups and increased with both the level of remoteness and socioeconomic disadvantage. Indigenous females had the highest rate of death at 65 deaths per 100,000 population followed by males living in remote and very remote areas and males from the lowest socioeconomic group, both with 60 deaths per 100,000 population.

Note: Age-standardised to the 2001 Australian population.
Source: AIHW National Mortality Database. (Data table 16)

Primary Health Networks

In 2018, the rates for death with an AF cause varied across 31 PHN regions, ranging from 20 to 66 deaths per 100,000 population (Data table 17).

The rate was 3.3 times as high in the PHN region with the highest rate (Western Queensland) compared with the PHN region with the lowest rate (Perth North).

Trends

Between 2001 and 2015, there was a 50% relative increase in the age-standardised rate of deaths with an AF cause (underlying or associated)—from 30 per 100,000 population in 2001 to 45 per 100,000 population in 2015.

The trend then stabilised in the following 3 years to 2018.

The age-standardised death rate for males rose from 36 to 49 per 100,000 population between 2001 and 2018, and the female rate from 26 to 37 per 100,000 population (Figure 11).

AF was listed as an underlying or associated cause in 4.6% of all deaths in 2001, increasing to 9.0% of death in 2018.

Figure 11: Atrial fibrillation deaths rate, underlying and associated cause, by sex, 2001 to 2018

The line graph shows the trend increase of atrial fibrillation deaths between 2001 and 2019. Rates peaked for males and females in 2015, at 50 and 40 per 100,000 population respectively. The rate of death stabilised and slightly decreased for both males and females in the years following, with 49 and 37 deaths per 100,000 population respectively, in 2018.

Note: Age-standardised to the 2001 Australian population.
Source: AIHW National Mortality Database. (Data table 19)

Atrial fibrillation as underlying cause of death

In 2018, AF was listed as the underlying cause of 2,235 deaths in Australia. The listed underlying cause of death is the condition, disease or injury that initiated the sequence of events leading directly to death; that is, the primary or main cause. For each death, only a single underlying cause is selected from all the conditions reported on a death certificate.

Between 2001 and 2018, the proportion of deaths in Australia with the underlying cause of AF increased 2.3-fold from 0.6% to 1.4% of all deaths (Figure 12).

Figure 12: Atrial fibrillation deaths as percent of total deaths, underlying cause and associated cause, 2001–2018

The line graph shows the trend increase of atrial fibrillation deaths from 2001 to 2018. Atrial fibrillation as an associated cause of death accounted for a greater percentage of total deaths than atrial fibrillation as an underlying cause of death across all years. Atrial fibrillation as an associated cause of death rose from 3.98 per cent of total deaths in 2001 to 7.55 per cent of total deaths in 2018. Atrial fibrillation as an underlying cause of death also increased over the same period, from 0.59 per cent of total deaths in 2001 to 1.41 per cent of total deaths in 2018.

Source: AIHW National Mortality Database. (Data table 19)

Atrial fibrillation as associated cause of death

In 2018, AF was listed as an associated cause of 11,960 deaths in Australia—7.6% of all deaths. Between 2001 and 2018, the proportion of deaths in Australia with an associated cause of AF almost doubled, from 4.0% to 7.6% of all deaths (Figure 12).

Almost half (44%) of the deaths listing AF as an associated cause in 2018 had a disease of the circulatory system listed as the underlying cause (Figure 13).

Figure 13: Underlying causes of death when atrial fibrillation is an associated cause of death, 2018

The pie chart shows the underlying causes of death when atrial fibrillation is an associated cause of death in 2018. Diseases of the circulatory system accounted for the greatest proportion of underlying causes of deaths (44%25) followed by other (23%25), neoplasms (16%25), diseases of the respiratory system (11%25) and mental and behavioural disorders (6%25).

Source: AIHW National Mortality Database.

At the specific disease level, the leading underlying causes of death where AF was listed as an associated cause included:

  • chronic ischaemic heart disease (13.2%)
  • acute myocardial infarction (heart attack) (6.7%)
  • chronic obstructive pulmonary disease (COPD) (5.1%)
  • stroke, not specified as haemorrhage or infarction (4.5%),
  • unspecified dementia (4.4%). (Data table 18)

References

Kornej J, Borschel CS, Benjamin EJ & Schnabel RB 2020. Epidemiology of atrial fibrillation in the 21st century: novel methods and new insights. Circulation Research 127:4–20.

Nedkoff L, Kelty EA, Hung J, Thompson SC & Katzenellenbogen JM 2020. Differences in stroke risk and cardiovascular mortality for Aboriginal and other Australian patients with atrial fibrillation. Medical Journal of Australia 212:215–21.

 

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