Temporal trends in heart failure and stroke-related mortality in the United States, 1999-2023

Area of Science:

• Cardiovascular epidemiology
• Public health surveillance

Background:

• Heart failure (HF) and stroke are leading causes of cardiovascular mortality in the U.S.
• The combined impact of HF and stroke on mortality trends has been understudied nationally.

Purpose of the Study:

• To investigate temporal, demographic, and geographic trends in stroke-related deaths among individuals with heart failure from 1999 to 2023.
• To identify disparities in mortality rates and trends across different population subgroups and regions.

Main Methods:

• Utilized CDC WONDER database for multiple cause-of-death records (adults ≥25 years) listing both HF and stroke.
• Calculated age-adjusted mortality rates (AAMRs) per 100,000 using the 2000 U.S. standard population.
• Employed joinpoint regression to analyze trends and average annual percent changes (AAPCs).

Main Results:

• Observed 465,695 deaths attributed to both HF and stroke between 1999 and 2023.
• AAMRs decreased from 13.46 in 1999 to 7.19 in 2019, then rose to 8.69 by 2023.
• Higher AAMRs noted in men, NH Black individuals, younger adults (25-44), the South, and rural areas, with slower declines and earlier increases in these groups.

Conclusions:

• Despite overall long-term declines, recent increases in stroke-related mortality among HF patients, especially post-pandemic, signal critical issues.
• Disparities persist and are worsening among younger, male, and racially minoritized populations.
• Urgent attention to health equity and access is required to address these concerning mortality trends.