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Trends and Racial-Geographic Disparities in Coexisting Coronary Artery Disease (CAD) and Heart Failure (HF) Related
Sahil Bhagia1, Muhammad Salman Mustafa1, Daniyal Khalid1
1Department of Medicine and Surgery Dow University of Health Sciences Karachi Sindh Pakistan.
Insights
Mortality from coronary artery disease (CAD) and heart failure (HF) combined has decreased since 1999. However, significant disparities persist across demographics and regions, requiring targeted interventions for high-risk groups.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Epidemiology
Background:
- Coronary artery disease (CAD) and heart failure (HF) are common comorbidities.
- National mortality trends for the combined presence of CAD and HF are understudied.
Purpose of the Study:
- To examine U.S. mortality trends for deaths involving coexisting CAD and HF from 1999 to 2024.
- To identify demographic, geographic, and clinical disparities in mortality rates.
Main Methods:
- Analysis of CDC WONDER multiple-cause-of-death data for adults aged 25 years and older.
- Age-adjusted mortality rates (AAMR) standardized to the 2000 U.S. population.
- Joinpoint regression to estimate annual percent changes and stratification by various factors.
Main Results:
- Over 2.9 million deaths involved coexisting CAD and HF between 1999 and 2024.
- The overall AAMR significantly declined from 71.6 to 43.7 per 100,000.
- Persistent disparities noted by sex, race/ethnicity, geographic region (Midwest highest, Northeast lowest), urban/rural status, and age group.
Conclusions:
- While overall mortality for coexisting CAD and HF has decreased, significant disparities remain.
- Targeted prevention strategies are crucial to address the burden of ischemic heart failure in vulnerable populations.
Background:
Coronary artery disease (CAD) and heart failure (HF) frequently coexist, yet national mortality trends capturing both conditions together remain understudied. We examined U.S. mortality trends where CAD and HF coexisted from 1999 to 2024.
Methods:
We analyzed CDC WONDER multiple-cause-of-death data for adults ≥ 25 years to identify deaths with coexisting CAD and HF. Age-adjusted mortality rates (per 100,000) were standardized to the 2000 U.S. population. Joinpoint regression estimated annual percent changes, and mortality was stratified by demographics, region, and clinical presentation.
Results:
From 1999 to 2024, 2,930,567 deaths involved coexisting CAD and HF, with 32.82% occurring in inpatient settings. The AAMR declined significantly from 71.6 in 1999 to 43.7 in 2024. Men had higher mortality than women (67.5 vs. 39.8), although declines were steeper in women. White adults had the highest AAMR (52.6), while Asian or Pacific Islanders had the lowest (25.0). The Midwest recorded the highest mortality (54.6), and the Northeast the lowest (47.1). Mortality was higher in rural areas than in urban areas (63.6 vs. 49.5). Older adults had the greatest burden (240.9), whereas younger adults showed increasing trends after 2010. Chronic ischemic cardiomyopathy recorded higher mortality as compared to acute myocardial infarction (9.85 vs. 4.41), although the decline was greater for chronic infarctions. State-level variation was notable, with West Virginia and Oklahoma consistently among the highest.
Conclusion:
Mortality involving coexisting CAD and HF declined overall but showed persistent demographic and geographic disparities. Targeted prevention strategies are needed to reduce the ischemic HF burden in high-risk populations.
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