Trends in Heart Failure-Related Mortality Among Older Adults in the United States From 1999-2019

Temporal and demographic disparities in mortality trends for heart failure and COPD-associated heart failure in U.S. Adults: A 1999-2020 analysis of CDC WONDER data

BACKGROUND

Heart failure (HF) carries varying mortality based on demographic distribution. Moreover, the interaction of HF with chronic obstructive pulmonary disease (COPD) raises this mortality. In this study, implementing national databases over a long time could assist in understanding mortality rates in patients suffering from two significant chronic diseases, HF and COPD.

METHODS

This analysis utilized the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) system to assess the mortality trends between HF and COPD-associated HF in US adults aged 25-85+ from 1999 to 2020.

RESULTS

This investigation detected a total of 6,755,700 deaths occurred in patients with HF in ages above 25. Fatalities of 1,141,819 (16.9 %) were associated with HF and comorbid COPD. Age-adjusted mortality Rates (AAMR) of HF-related deaths decreased from 162.7 to 154.4. (Average Annual Percentage Changes (AAPC): -0.49, 95 % CI: -0.63 to -0.34, p < 000001, while the overall AAMR for HF with COPD among adults increased from 24.5 in 1999 to 28.2 in 2020. Men had significantly higher HF-related AAMRs and HF with comorbid COPD-related mortality than women. HF-related AAMRs were highest among NH Black or African Americans, followed by NH Whites. At the same time, on the other side, HF and COPD had the highest mortality in non-Hispanic (NH) White individuals, followed by NH Black individuals, then Hispanic individuals. Mortality in HF with COPD was the highest in the Northeast, then the Midwest, South, and least in the West states.

CONCLUSION

Implementation of a CDC database provided guidance over two decades about the US population mortality attributed to HF with and without the presence of COPD, which contributed to a better understanding of national trends in prevailing diseases with remarkable chronicity.

Shifting trends and disparities in colorectal cancer and heart failure-related mortality in the United States: A two-decade retrospective analysis

BACKGROUND

Colorectal cancer (CRC) and heart failure (HF) are significant contributors to morbidity and mortality, particularly when they co-occur. This study aims to analyze the trends in mortality related to both CRC and HF from 1999 to 2020, identifying demographic and geographical variations that could inform targeted interventions.

METHODS

We examined death certificate data from the CDC WONDER database to assess trends in CRC and HF-related mortality over a 22-year period. We calculated annual percentage changes (APCs) in age-adjusted mortality rates (AAMRs), stratified by race, gender geographical region and age group.

RESULTS

Between 1999 and 2020, there were 60,918 deaths attributed to CRC and HF. The AAMRs declined from 9.6 per 100,000 in 1999 to 0.92 in 2015, followed by an increase to 1.12 in 2020. Men consistently exhibited higher AAMRs (1.6) compared to women (1.07). By race, non-Hispanic Black individuals had the highest AAMRs (1.36), closely followed by non-Hispanic Whites (1.35), with Hispanic (0.69) and non-Hispanic Asian or Pacific Islander individuals (0.54) having lower rates. Geographical analysis revealed that the Midwest had the highest AAMR (1.53), with the Northeast (1.27), West (1.24), and South (1.16) following. Metropolitan areas recorded higher AAMRs (1.69) compared to non-metropolitan areas (1.19).

CONCLUSION

The study indicates a worrying rise in CRC and HF-related mortality from 2015 to 2020, following earlier declines. This upward trend across diverse demographics and regions highlights an urgent need for targeted public health strategies and healthcare policies to address these increases.

Where Adults With Heart Failure Die: Insights From the CDC-WONDER Database

BACKGROUND

Heart failure (HF) is associated with high mortality rates and substantial health care costs. While there is growing emphasis on integrating palliative care for patients with HF, limited data exist on the locations where adults with HF spend their final days. The study aimed to analyze the location and circumstances of death among adults with HF in the United States using Centers for Disease Control and Prevention's Wide-ranging Online Data for epidemiological Research data.

METHODS

Mortality data from individuals aged ≥20 years, with HF listed as the cause of death between 1999 and 2023, were analyzed. The places of death were categorized as the emergency room, hospice/nursing home, inpatient medical facility, or home. Multinomial logistic regression was performed to examine the associations between demographic factors and death location.

RESULTS

HF-related mortality rates declined from 1999 (3.60% and 143.6 age-adjusted mortality rate) to 2010 (3.47% and 123.1 age-adjusted mortality rate). However, rates gradually increased thereafter, reaching 5.18% and 168.1 age-adjusted mortality rate in 2023. Deaths at home nearly doubled, rising from 18.41% (50 648 of 275 132) in 1999 to 33.47% (132 470 of 395 826) in 2023. Hospice/nursing home deaths increased from 30.95% (85 144 of 275 132) in 1999 to 34.71% (116 634 of 336 014) in 2017, but declined to 29.54% (116 931 of 395 826) by 2023. Young adults (20-34 years) had the highest proportion of inpatient deaths. Sex, ethnicity, and urbanization were significant predictors of death location, with men, White individuals, and those in large metropolitan areas more likely to die in medical facilities.

CONCLUSIONS

This study underscores the shifting trends in the locations of death among patients with HF, with a ≈2-fold increase in HF-related deaths occurring at home over the past 2 decades. The recent decline in hospice/nursing home deaths, following a period of steady growth, calls for an in-depth examination of contributing barriers. Further research is essential to understand the sociodemographic factors driving disparities in HF-related death locations.

Trends and Disparities in Heart Failure Mortality Among Hypertensive Older Adults in the United States: A 22-Year Retrospective Study

Hypertension (HTN) is a significant risk factor for heart failure (HF), and both significantly contribute to cardiovascular mortality. This study aims to examine trends and disparities in HF-related mortality among hypertensive older adults (≥65 years) in the United States from 1999 to 2020. Centers for Disease Control and Prevention-Wide-ranging Online Data for Epidemiologic Research (CDC-WONDER) database data were analyzed, focusing on HTN as the underlying cause and HF as the contributing cause of death. Age-adjusted mortality rates (AAMRs) and crude rates were stratified by gender, race/ethnicity, age groups, urban-rural status, and geographic regions. The Joinpoint regression program was used to calculate annual percentage changes (APCs) and average annual percentage changes (AAPCs). A total of 259 079 HF-related deaths occurred among hypertensive older adults, with an overall AAMR increase from 11.27 in 1999 to 41.05 in 2020, indicating a clear upward trend (AAPC: 5.51%). Females had higher AAMRs (28.57) than males (25.56); however, males showed a steeper rise in mortality (AAPC: 6.15% vs. 5.23%). Non-Hispanic Blacks had the highest AAMR (43.99), while NH Whites exhibited the most significant increase (AAPC: 5.92%). Mortality rates were highest in the West (AAMR: 34.57) and lowest in the Northeast (21.44). Non-metropolitan areas had a higher AAMR than metropolitan areas (30.69 vs. 26.52). These findings emphasize the necessity for targeted interventions to diminish disparities and tackle increasing mortality rates in vulnerable populations, especially among women, NH Blacks, individuals in the West, and those living in non-metropolitan areas.

Trends in Necrotizing Fasciitis-Associated Mortality in the United States 2003-2020: A CDC WONDER Database Population-Based Study

BACKGROUND

Necrotizing fasciitis (NF) is a severe and rapidly progressing soft tissue infection with high mortality rates. Despite the urgency of this condition, there is limited research on long-term NF-related mortality trends in the United States.

OBJECTIVE

This study aims to analyze NF-related mortality trends in adults aged 25 and older in the United States from 2003 to 2020, focusing on variations by sex, race/ethnicity, and geographic region.

METHODS

NF-related deaths were identified using the CDC WONDER database through the ICD-10 code M72.6. Crude and age-adjusted mortality rates (AAMRs) were calculated across demographic groups and regions. Temporal trends were assessed using the joinpoint regression, providing annual percent change (APC) in mortality rates.

RESULTS

From 2003 to 2020, a total of 19,158 NF-related deaths were recorded, marking a 120.6% increase, rising from 824 deaths in 2003 to 1842 in 2020. The overall AAMR increased from 0.44 per 100,000 in 2003 to 0.71 per 100,000 in 2020. Males consistently had higher mortality rates than females and both sexes saw a sharp rise in AAMR after 2015. By race/ethnicity, American Indian or Alaska Native populations exhibited the highest mortality rates, followed by Black or African American individuals. Regional trends revealed that the West had the highest AAMR, whereas the Northeast recorded the lowest. A significant rise in mortality rates was observed across all regions after 2014. Additionally, urban-rural analysis indicated that large central metropolitan areas had consistently elevated mortality rates, whereas smaller metropolitan and noncore areas experienced sharper increases.

CONCLUSIONS

NF-related mortality has significantly risen in the United States since 2014, with distinct disparities based on sex, race, and geographic region. Contributing factors may include chronic conditions, healthcare access issues, and climate-related events. Public health interventions focusing on early diagnosis, timely treatment, and addressing healthcare inequities are essential for improving outcomes (highlighted shows corrections).

Temporal trends in heart failure and acute kidney injury-related mortality in the U.S.: a 21-year retrospective analysis of the CDC WONDER database

BACKGROUND

Heart failure (HF) and acute kidney injury (AKI) are leading contributors to morbidity and mortality in the United States, often coexisting as part of the cardiorenal syndrome. Understanding long-term mortality trends is crucial for guiding healthcare policies and interventions. This study analyses national trends in HF- and AKI-related mortality from 1999 to 2020, with a focus on age-adjusted mortality rates (AAMR) and disparities across gender, race/ethnicity, urbanization, and geographic regions.

METHODS

We conducted a retrospective analysis using the CDC WONDER database, extracting mortality data for adults aged 25-85 years. HF- and AKI-related deaths were identified using ICD-10 codes. Temporal trends in AAMR were evaluated using Joinpoint regression, and subgroup analyses were performed to assess disparities.

RESULTS

A total of 219,243 HF- and AKI-related deaths were recorded. The overall AAMR increased from 3.56 per 100,000 in 1999 to 5.30 in 2020 (AAPC: 1.52%; p < 0.001). Males had a higher AAMR than females (5.80 vs. 3.84). NH Black individuals exhibited the steepest rise in mortality, whereas NH White and Asian populations showed stabilization. Nonmetropolitan areas had higher AAMRs compared to metropolitan regions. State-level disparities revealed that North Dakota and West Virginia had the highest mortality rates, whereas Florida and Arizona had the lowest.

CONCLUSION

HF- and AKI-related mortality has risen significantly over the past two decades, with pronounced disparities across demographic and geographic subgroups. These findings underscore the need for targeted interventions to address healthcare inequities and improve outcomes in high-risk populations.

The role of environmental access to exercise opportunities in cardiovascular mortality: evidence from a nationwide study

BACKGROUND

Environmental access to exercise opportunities plays a crucial role in determining the level of physical activity within a population. However, it is unclear how environmental factors contribute to disparities in physical activity and health outcomes. We explored the associations between county-level access to exercise opportunities and cardiovascular disease (CVD) mortality across US counties.

METHODS

We conducted an ecological analysis using aggregated data from two primary sources: the County Health Rankings and Roadmaps data and CDC WONDER mortality data. We compared county-level age-adjusted CVD mortality across county-level quartiles of access to exercise opportunities and physical inactivity. Stratification was performed based on age, sex, race, and urbanization variables. The rate ratio (RR) for CVD mortality was also calculated using generalized linear models.

RESULTS

We observed significant variations in CVD mortality across different levels of exercise opportunities access and physical inactivity, which was consistent across all demographic subgroups (P < 0.001). Access to exercise opportunities was significantly associated with a reduced risk of CVD mortality (RR = 0.93 [0.91-0.95]), and the association was most pronounced for acute myocardial infarction (AMI) mortality (RR, 0.80 [0.76-0.85]). The county-level physical inactivity was significantly associated with an increased risk of CVD mortality (RR, 1.16 [1.14-1.17]), especially for ischemic heart disease (IHD) (RR, 1.35 [1.31-1.38]) and AMI (RR, 1.32 [1.25-1.38]). All demographic subgroups demonstrated similar benefits in reducing the risk of CVD by improving the county-level indicators of physical activity.

CONCLUSIONS

Counties have the potential to make significant environmental strides in improving the cardiovascular health of their populations by enhancing access to exercise opportunities in the context of urbanization.

Longitudinal Trends in Heart Failure Mortality Linked to Coronary Artery Disease Among Adults 65 years and older

BACKGROUND

Heart failure (HF) in patients with coronary artery disease (CAD) is a leading cause of mortality among older adults in the United States. This study examines trends in HF with CAD-related mortality among adults aged 65 and older.

METHODS

A retrospective analysis was performed using the CDC WONDER database death certificates from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region.

RESULTS

HF associated with CAD led to 1,597,451 deaths among adults > 65, primarily occurring in medical facilities (37.1%). The AAMR for HF with CAD decreased from 241.7 in 1999 to 156.2 in 2020 (AAPC: -2.23, p < 0.001), which was significant from 1999 to 2014. Men had higher AAMRs than women (227.4 vs. 137.1), with women's rates declining more significantly (AAPC: -3.23, p < 0.001). White adults had the highest AAMRs (183.0), while Asians/Pacific Islanders (81.6) recorded the lowest. Geographically, AAMRs varied, from 92.1 in Hawaii to 257.3 in West Virginia, with the Midwest showing the highest mortality (191.0). Nonmetropolitan areas exhibited higher AAMRs than metropolitan areas (202.6 vs. 166.1) CONCLUSION: Our study reveals striking disparities in HF-related mortality among adults aged 65 years and older in the United States. While AAMRs decreased overall from 1999 to 2014, they have reached an inflection point since 2019, indicating rising mortality rates. Persistent inequalities underscore the critical need for targeted public health interventions to address these issues.

Gaps in care delivery for patients with heart failure: A qualitative study of patients with multiple readmissions

BACKGROUND

Despite significant advances in the management of patients with heart failure with preserved and reduced ejection fraction (HFpEF and HFrEF), readmission rates remain high.

OBJECTIVES

In this study, we sought to understand the experiences and gaps in care delivery among heart failure (HF) patients with multiple readmissions.

METHODS

We conducted a qualitative study using semistructured interviews with patients admitted with HF exacerbation and who had a prior admission for HF exacerbation within 1 year of the interview. We analyzed the interview contents using thematic analysis. Additionally, we reviewed the medical charts and collected information regarding patients' disease course and treatments.

RESULTS

Our study included 24 patients, 54% had HFrEF, and 46% had HFpEF. Two major themes emerged; the first theme was centered on hospital readmissions, which often uncovered gaps in communication and deficiencies in discharge education. Patients expressed frustration with recurrent admissions, identified communication challenges while inpatient, and highlighted the shortcomings of the current discharge education models. The second theme explored the ways in which fragmented understanding of HF as a result of gaps in effective care delivery impacted multiple domains of care spanning the spectrum from initial diagnosis to prognosis. The interviews highlighted important differences between patients with HFrEF and HFpEF.

CONCLUSIONS

Patients with HF and recurrent admissions shared multiple gaps in care delivery with important differences noted between HFpEF and HFrEF patients. These findings can inform the design of future targeted interventions to ensure effective care delivery to a high-risk population.

Unveiling Disparities in Heart Failure and Cirrhosis Related Mortality: CDC WONDER 1999 to 2020

BACKGROUND

Patients with heart failure and cirrhosis are a highly vulnerable population due to increased risk of morbidity and mortality. There is limited evidence on mortality trends by age, sex, race, and geographic location in contemporary years in this vulnerable population.

METHODS

Multiple cause of death files from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research from 1999 to 2020 in age ≥ 25 years were used. Death was presented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint Trend Analysis Software was used to determine annual percentage change (APC). These were stratified by age, sex, race and ethnicity, location of death (medical facilities, home, hospice, nursing home), regions (Northeast, Midwest, South, and West), states, and rural-urban areas.

RESULTS

Total deaths were 98,530 and AAMR was 2.05. The APC from 2001 to 2009 was - 2.80, but from 2009 to 2014 was + 3.16, 2014 to 2018 was + 7.88, and 2018 to 2020 was + 12.23. AAMR were higher in non-Hispanic American Indians (NHAI) (4.11), with a sharp rise in mortality (APC + 14.58, 2013 to 2020). Higher AAMR were observed in the South (2.23) and West (2.24), West Virginia (3.45) and Oklahoma (3.23), rural areas (2.52), males (2.86), and age ≥ 75 years (9.61). Most deaths took place inpatient (48,255).

CONCLUSION

There was an initial decline in mortality, however, a rise was observed in recent years. NHAI have the highest AAMR. Higher AAMR are observed in males, in the South and West, and in rural areas. We emphasize the need for targeted interventions addressing these disparities by improving access to resources, surveillance, and management strategies for this vulnerable population.

Associations of combined accelerated biological aging and genetic susceptibility with incidence of heart failure in a population-based cohort study

The global aging population raises concerns about heart failure (HF), yet its association with accelerated biological age (BA) remains inadequately understood. We aimed to examine the longitudinal association between BA acceleration and incident HF risk, assess its modifying effect on genetic susceptibility, and how much BA acceleration mediates the impact of modifiable health behaviors on incident HF. We analyzed 274,608 UK Biobank participants without HF at baseline. Two BA accelerations (Biological Age Acceleration [BioAgeAccel] and Phenotypic Age Acceleration [PhenoAgeAccel]) were calculated by regressing clinical biomarker-based BA on chronological age, with higher values indicating accelerated aging. Health behavior scores were computed based on diet, physical activity, tobacco/nicotine, sleep, and BMI. Genetic risk scores (GRS) were calculated by 12 HF-associated loci. During a median follow-up of 13.5 years, 8915 HF cases were documented. Each standard deviation increase in BioAgeAccel and PhenoAgeAccel was associated with an increased incident HF risk, yielding HRs of 1.45 (95% CI, 1.42-1.48) and 1.42 (95% CI, 1.40-1.45), respectively. Participants with high GRS and highest quartile of BioAgeAccel had an HR of 2.69 (95% CI, 2.42-2.99), and for PhenoAgeAccel, an HR of 2.83 (95% CI, 2.52-3.18), compared to those with low GRS, and lowest quartile. Additive interactions were observed between GRS and BA accelerations. Health behaviors reduced HF risk, with 21.1% (95% CI, 19.5%-22.8%) mediated by decreased BioAgeAccel and 20.9% (95% CI, 19.5%-22.6%) by decreased PhenoAgeAccel. Accelerated BA is associated with an increased incident HF risk, with an additive effect when combined with genetic susceptibility. Maintaining health behaviors may help mitigate BA aging and reduce HF risk.

In-Hospital Adverse Events in Heart Failure Patients: Incidence and Association with 90-Day Mortality

BACKGROUND

In-hospital adverse events (IHAEs) are key patient safety indicators but are not comprehensively assessed among patients hospitalized for heart failure (HF). The authors aimed to determine the association of IHAEs with downstream outcomes.

METHODS

This retrospective multicenter cohort study analyzed data from patients hospitalized for HF in 17 acute care hospitals (2010-2023). The research team abstracted 36 IHAEs and grouped them into eight composite categories. The primary outcome was 90-day all-cause mortality, and secondary outcomes included length of stay (LOS), in-hospital mortality, and 90-day postdischarge all-cause readmission.

RESULTS

Of the 11,169 hospitalized HF patients (median age 77.7 years; 47.0% women; 7.1% non-white; 39.8% from rural counties; 78,869 hospital bed-days), IHAEs occurred at varying frequency across the composite IHAE categories: general 4.6%, cardiovascular 6.6%, pulmonary 11.7%, endocrine and metabolism 9.2%, renal and electrolyte 9.1%, gastrointestinal 4.0%, neurological 2.7%, and hospital-acquired infection (HAI) 3.2%. Except for the renal and electrolyte (hazard ratio [HR] 0.92, p = 0.2956), IHAE in any other category was consistently associated with higher 90-day mortality (HRs 1.50-2.42, p < 0.0001 for all). Associations with secondary outcomes varied by IHAE categories: LOS increased in the general (incident rate ratio [IRR] 1.09), pulmonary (IRR 1.65), neurological (IRR 1.37), and HAI (IRR 1.09) categories (p < 0.0001). In-hospital mortality was higher in all categories except gastrointestinal. The 90-day readmission rate was elevated in the gastrointestinal (HR 1.85), neurological (HR 1.89), and HAI (HR 1.66) categories (p < 0.0001). Guideline-focused medical treatment (GFMT) was associated with reduced mortality in patients with and without IHAEs.

CONCLUSION

HF cohorts with specific composite IHAEs experience higher in-hospital and 90-day all-cause mortality and increased health care resource utilization. This elevated mortality risk may be mitigated by GFMT, with potential tailoring to each specific IHAE category.

Cardiac preservation using ex vivo organ perfusion: new therapies for the treatment of heart failure by harnessing the power of growth factors using BMP mimetics like THR-184

As heart transplantation continues to be the gold standard therapy for end-stage heart failure, the imbalance between the supply of hearts, and the demand for them, continues to get worse. In the US alone, with less than 4,000 hearts suitable for transplant and over 100,000 potential recipients, this therapy is only available to a very few. The use of hearts Donated after Circulatory Death (DCD) and Donation after Brain Death (DBD) using ex vivo machine perfusion (EVMP) is a promising approach that has already increased the availability of suitable organs for heart transplantation. EVMP offers the promise of enabling the expansion of the overall number of heart transplants and lower rates of early graft dysfunction. These are realized through (1) safe extension of the time between procurement and transplantation and (2) ex vivo assessment of preserved hearts. Notably, ex vivo perfusion has facilitated the donation of DCD hearts and improved the success of transplantation. Nevertheless, DCD hearts suffer from serious preharvest ischemia/reperfusion injury (IRI). Despite these developments, only 40% of hearts offered for transplantation can be utilized. These devices do offer an opportunity to evaluate donor hearts for transplantation, resuscitate organs previously deemed unsuitable for transplantation, and provide a platform for the development of novel therapeutics to limit cardiac injury. Bone Morphogenetic Protein (BMP) signaling is a new target which holds the potential for ameliorating myocardial IRI. Recent studies have demonstrated that BMP signaling has a significant role in blocking the deleterious effects of injury to the heart. We have designed novel small peptide BMP mimetics that act via activin receptor-like kinase (ALK3), a type I BMP receptor. They are capable of (1) inhibiting inflammation and apoptosis, (2) blocking/reversing the epithelial-mesenchymal transition (EMT) and fibrosis, and (3) promoting tissue regeneration. In this review, we explore the promise that novel therapeutics, including these BMP mimetics, offer for the protection of hearts against myocardial injury during ex vivo transportation for cardiac transplantation. This protection represents a significant advance and a promising ex vivo therapeutic approach to expanding the donor pool by increasing the number of transplantable hearts.

Trends in hypertensive heart disease-related mortality among older adults in the USA: a retrospective analysis from CDC WONDER between 1999 and 2020

BACKGROUND

While hypertensive heart disease (HHD) has been widely studied, this study uniquely examines the impact of the COVID-19 pandemic on HHD mortality trends, which has not been thoroughly explored in the current literature. The pandemic's effects on healthcare access, economic instability, and social isolation present new challenges and opportunities for understanding HHD mortality among the elderly.

RESULTS

Age-adjusted mortality rates (AAMRs) increased overall between 1999 and 2020, from 36.7 to 133.9 per 100,000 people, according to analysis. The data on AAMRs indicated a consistent rise from 1999 to 2017, with a notable uptick from 2017 to 2020. An investigation based on gender revealed that older men had a consistently higher AAMR than older women. The biggest AAMRs were found among the non-Hispanic (NH) Black or African-American population, according to variations in AAMR based on race and ethnicity. Geographic differences between states revealed that compared to Nebraska, Oregon, North Dakota, Maine, and Minnesota, the District of Columbia, Oklahoma, Nevada, Vermont, and Mississippi had substantially higher AAMRs. The West, Northeast, and Midwest were in second place with a continuously higher AAMR, followed by the South. Furthermore, compared to non-metropolitan areas, metropolitan areas had a higher AAMR.

CONCLUSION

The importance of including demographic and geographic factors in public health planning and interventions is highlighted by these findings, which provide insightful information on mortality trends associated with HHD in the elderly.

Patterns in mortality associated with heart failure and lung cancer among older adults in the United States: An analysis of 20 years

Background

Despite an established association between heart failure (HF) and lung cancer (LC), there is limited evidence available regarding mortality patterns among the older (≥65 years) population in the United States.

Methods

The mortality data, spanning 1999 to 2019, was surveyed using the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database with HF and LC identified as underlying or contributing causes of death. Crude and age-adjusted mortality rates (AAMR) were calculated per 100,000 individuals. Joinpoint regression was applied to establish annual percent changes (APCs) for the trends in years, demographics (sex, race), and geographical regions.

Results

Between 1999 and 2019, the overall AAMR slightly decreased from 13.0 to 11.4. However, the AAMRs significantly increased (APC: 6.37; 95 % CI: 3.39 to 8.23) from 2017 to 2019. Males had double the AAMRs compared to females (overall AAMR: 15.7 vs. 8.0), yet both sexes experienced a final incline in death rates. Among the distinct racial and ethnic groups, non-Hispanic (NH) Whites (11.9) and NH Black/African Americans (10.9) portrayed the highest AAMRs. Patients most commonly died in medical facilities (41.03 %). Geographical disparities were evident with higher AAMRs in non-metropolitan areas (14.3) and the Midwest (12.7). States with the highest fatality involved West Virginia, Oklahoma, Kentucky, Mississippi, and Arkansas.

Conclusion

The abrupt rise in overall mortality rates for HF and LC from 2017 to 2019 is noteworthy. A focused analysis of demographic and geographic disparities is warranted to address this emerging trend.

Temporal trends and disparities in mortality from hypertensive heart disease with heart failure: A nationwide analysis (1999-2020)

Introduction

By 2019, nearly 20 million people worldwide had hypertensive heart disease (HHD), resulting in over 1.1 million deaths and 21.5 million disability-adjusted life years (DALYs). Hypertension is a significant factor in heart failure (HF), contributing to about a quarter of cases, increasing to 68 % in older adults. This study examines mortality trends among patients in the United States (US) affected by HHD and HF.

Methodology

This study used Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) data from 1999 to 2020 to analyze deaths in the United States among adults aged 25 and older from HHD and (congestive) HF (ICD-10 code I11.0). Age-adjusted mortality rates (AAMRs) and annual percent change (APC) were calculated by year, sex, age groups, race/ethnicity, geographics, and urbanization status.

Results

Between 1999 and 2020, AAMRs increased from 3.7 to 13.5 per 100,000 population, with a steep increase from 2014 to 2020 (APC: 14.44; 95 % CI: 11.12 to 20.62). Men had slightly higher AAMRs than women (6.3 vs. 6.1). Additionally, AAMRs were highest among non-Hispanic (NH) Black individuals. Non-metropolitan areas had higher AAMRs than metropolitan areas (6.6 vs 6.2). The average AAMR during the COVID-19 pandemic (2020-2022) was nearly three times the pre-pandemic average (1999-2019).

Conclusions

Mortality from combined HHD and HF has risen since 1999, with higher rates among men, NH Black individuals, and those in non-metropolitan areas. Policy changes are needed to address these disparities and enhance healthcare equity.

Trends and regional variations in chronic ischemic heart disease and lung cancer-related mortality among American adults: Insights from retrospective CDC wonder analysis

Introduction

Lung cancer remains the leading cause of cancer-related mortality in the United States and shares cardiovascular risk factors with chronic ischemic heart disease (CIHD). However, the cumulative mortality burden of these comorbid conditions is underexplored. This study aims to retrospectively assess mortality trends among American adults with concurrent lung cancer and CIHD.

Methods

We utilized death certificate data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, encompassing ICD-10 codes for individuals aged ≥45 years from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 population, annual percentage change (APC), and corresponding 95 % confidence intervals (CIs) were calculated. Data were further stratified by year, sex, race, and geographic region (state, rural-urban, and census regions).

Results

A total of 214,785 deaths were identified in adults aged ≥45 years with comorbid lung cancer and CIHD. The overall AAMR between 1999 and 2020 was 8.4 per 100,000 (95 % CI: 8.3 to 8.4). AAMRs remained relatively stable from 1999 to 2005 (APC: -0.84 %; 95 % CI: -1.91 to 1.54), followed by a significant decline from 2005 to 2010 (APC: -2.37 %; 95 % CI: -5.58 to -0.61) and from 2010 to 2017 (APC: -4.72 %; 95 % CI: -7.61 to -3.60). A subsequent period of stability was noted between 2017 and 2020 (APC: 0.86 %; 95 % CI: -2.17 to 5.22). In 1999, men had a threefold higher mortality rate compared to women (AAMR: 17.8 vs. 5.7), with a non-significant decline by 2020 (AAMR: 10 vs. 4). Stratification by race/ethnicity revealed that non-Hispanic (NH) Whites exhibited the highest AAMR at 9.3, followed by NH American Indian or Alaska Natives (7.3), NH Blacks (6.8), Hispanic/Latinos (3.3), and NH Asians or Pacific Islanders (3.2). Geographically, AAMRs were highest in the Midwest (9.6), followed by the Northeast (8.8), South (8.4), and West (6.8). Non-metropolitan regions exhibited higher AAMRs compared to metropolitan areas (10.3 vs. 8.0). States in the top 90th percentile, such as West Virginia, Kentucky, Vermont, Ohio, and Rhode Island, had nearly triple the AAMRs compared to states in the lower 10th percentile, including Utah, Nevada, Arizona, New Mexico, and Hawaii.

Conclusions

From 1999 to 2020, mortality rates for adults aged ≥45 years with concurrent lung cancer and CIHD declined. The highest AAMRs were observed among men, NH Whites, individuals residing in the Midwest, and non-metropolitan populations. This highlights the need for a more comprehensive and tailored approach to managing these patients moving forward.

2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Effect of low-dose administration of carperitide for acute heart failure: the LASCAR-AHF trial

AIMS

The effects of low-dose carperitide on long-term clinical outcomes of patients with acute heart failure (AHF) have not yet been fully elucidated. This study aimed to evaluate the effects of low-dose intravenous carperitide on the long-term clinical outcomes of patients with AHF.

METHODS AND RESULTS

In this multicentre, open-label, randomized controlled trial, 247 patients with AHF received low-dose carperitide intravenously with standard treatment or matching standard treatment for 72 h from November 2014 to March 2021 across nine sites in Japan. The primary endpoint was a composite of all-cause death and heart failure hospitalization within 2 years. The primary endpoint was observed in 36 of 122 patients (29.5%) and 35 of 125 patients (28.0%) in the carperitide group and standard treatment groups, respectively [hazard ratio 1.26; 95% confidence interval (CI) 0.78-2.06, P = 0.827]. No significant differences were observed in the secondary endpoints, including cumulative urine volume at 72 h; change in the degree of dyspnoea over 72 h; and changes in brain natriuretic peptide, cystatin C, renin, aldosterone, and catecholamine levels at 72 h post-randomization between the groups. A greater decrease in the estimated glomerular filtration rate was observed in the carperitide group compared with the standard treatment group (inter-group difference -3.9 mL/min/1.73 m2; 95% CI -7.0 to -0.8).

CONCLUSION

In patients with AHF, low-dose carperitide did not reduce long-term mortality or hospitalization events when combined with standard treatment. Because patient enrolment was terminated prematurely, the study was underpowered and inconclusive.

Epidemiology of elderly burn patients in the United States: Mortality patterns and risk factors revealed by CDC WONDER database

INTRODUCTION

Burn-related fatalities pose a significant global public health challenge, with a substantial impact on the elderly population. This study examines two decades of burn-related mortality data in the United States, aiming to understand the trends, disparities, and contributing factors among adults aged 65 and older.

OBJECTIVES

The primary objectives of this study are to (1) analyze the trends in burn-related mortality rates among older adults, (2) investigate disparities based on gender, race and geographic regions, and (3) identify comorbidities and complications associated with burn-related deaths in this demographic.

METHODS

Data were obtained from the Centers for Disease Control and Prevention (CDC) using the National Center for Health Statistics database. The study cohort consists of individuals aged 65 and older who experienced burn-related deaths between 1999 and 2020. Various demographic variables, including age, sex, race/ethnicity, and location of death, were considered. The study also examined urban-rural classifications and regional differences. Mortality rates were calculated and adjusted for age. Joinpoint regression analysis was employed to assess trends in age-adjusted mortality rates over time. Modes of death and common comorbidities and complications were analyzed.

RESULTS

Between 1999 and 2020, a total of 96,498 older adults succumbed to burn injuries in the United States. Analysis revealed a concerning increase in burn-related mortality rates from 2012 onwards. Demographic disparities were evident, with older men consistently exhibiting higher mortality rates compared to women. Racial disparities were observed, with Black individuals experiencing the highest mortality burden. Geographic analysis indicated elevated mortality rates in Western states and rural areas. Accidents emerged as the leading cause of death, with ischemic heart disease and hypertensive diseases being prevalent comorbidities. Complications, with septicemia being the most common, contribute significantly to mortality.

CONCLUSION

Our analysis of 20 years of burn-related mortality data from the CDC reveals alarming trends in the United States. Unlike global trends, mortality rates have stagnated from 1999 to 2020, indicating a persistent public health challenge. Black individuals aged over 65 bear the brunt of burn-related mortality, facing the highest age-adjusted rates among all racial groups. Regional disparities are stark, with states in the top 90 % exhibiting significantly higher age-adjusted mortality rates compared to those in the bottom 10 %. Moreover, rural areas consistently report higher mortality rates than urban areas. Ischemic heart disease, hypertensive diseases, and other heart-related conditions emerge as prevalent comorbidities. To effectively reduce burn-related injuries and fatalities, targeted public health policies are imperative. These interventions must prioritize high-risk populations and adopt culturally sensitive approaches to promote safety. Additionally, enhancing access to healthcare and fire safety education is vital for mitigating the burden of burn-related mortality among the elderly population.

Trends in heart failure mortality in Sweden between 1997 and 2022

AIMS

Data from US have shown a reversal in the improvement of heart failure (HF)-related mortality over the last ~10 years. It is unknown whether these trends generalize to European universal healthcare systems. We assessed temporal trends in (i) HF-related mortality in the overall national population; and (ii) all-cause mortality following an incident HF diagnosis, overall and stratified by ejection fraction (EF), in Sweden between 1997 and 2022.

METHODS AND RESULTS

Annual mortality rates with a HF diagnosis as underlying cause were extracted from the Cause of Death Register. All-cause mortality following incident HF was assessed in two HF cohorts derived from the National Patient Register (NPR) and the Swedish HF Registry (SwedeHF). Temporal trends were presented as average annual percentage change (AAPC). Between 1997 and 2022, age-adjusted HF-related mortality in the general population declined from 33.4 to 23.8 per 100 000 individuals (AAPC -2.15%, p < 0.001). In the HF cohort from NPR (n = 423 092), all-cause mortality at 1, 3, and 5 years following a first diagnosis of HF was 25%, 46%, and 58%, respectively, in 2022; 1-year mortality declined (AAPC -1.10%, p < 0.001) over time regardless of age or sex. In SwedeHF (n = 63 753), the decline in 1-year mortality was less steep with increasing EF (AAPC -2.64%, p < 0.001; -2.30%, p = 0.062; and -2.16%, p = 0.032 in EF <40%, 40-49%, and ≥50%, respectively).

CONCLUSIONS

Heart failure-related mortality has declined over the last ~25 years in Sweden. All-cause mortality in patients with HF has also declined, more in HF with reduced than preserved EF, mirroring the different availability of life-saving treatments across the EF spectrum.

Psychological distress in heart failure patients: Implications for healthcare utilization and expenditure

AIMS

Psychological distress is prevalent among heart failure (HF) patients, yet its impact on healthcare expenditure and utilization remains understudied. The aim of this study was to investigate the prevalence of psychological distress in HF patients and its impact on healthcare expenditure and utilization.

METHODS AND RESULTS

We analysed data from the Medical Expenditure Panel Survey from January 2016 to December 2021, focusing on adults diagnosed with HF. We assessed the prevalence of psychological distress using the Kessler 6 (K6) questionnaire and examined its association with healthcare utilization and expenditures through multivariate regression models, adjusting for relevant covariates. Among 10 681 886 HF patients, 6.8% experienced psychological distress. The mean age was 69.9 years, and 50% were female. Multivariable analysis revealed significant associations between psychological distress and smoking (adjusted odds ratio [aOR] 2.87), Charlson comorbidity index ≥3 (aOR 3.05), and sleep disorders (aOR 2.82). Protective factors included exercise (aOR 0.40), higher education (aOR 0.89) and higher income levels (middle-income: aOR 0.19, high-income: aOR 0.20). HF patients with psychological distress incurred significantly higher annual total expenses ($14 709, p < 0.01), with inpatient costs ($6014, p = 0.02) and office-based expenses ($3993, p = 0.04) being notably elevated. Additionally, these patients exhibited more frequent annual emergency room visits (0.07 visits, p < 0.01), hospital discharges (0.2 discharges, p = 0.01), and nights spent in the hospital (1.4 nights, p < 0.01).

CONCLUSION

Psychological distress in HF patients is associated with significantly higher medical expenditure and healthcare utilization. These findings underscore the need for integrated care approaches and present possible areas for intervention to address this significant healthcare burden.

Demographics and regional trends of ischemic heart disease-related mortality in older adults in the United States, 1999-2020

BACKGROUND

Ischemic heart disease (IHD) has a significant impact on public health and healthcare expenditures in the United States (US).

METHODS

We used data from the CDC WONDER database from 1999-2020 to identify trends in the IHD-related mortality of patients ≥ 75 years in the US. AAMRs per 100,000 population and APC were calculated and categorized by year, sex, race, and geographic divisions.

RESULTS

Between 1999 and 2020, a total of 8,124,568 IHD-related deaths were recorded. Notable declines in AAMR were observed from 1999 to 2014 (APC: -3.86) and from 2014 to 2018 (APC: -2.55), with an overall increase from 2018 to 2020 (APC: 3.76). Older men consistently demonstrated higher AAMRs than older females, with AAMRs for both sexes decreasing steadily from 1999 to 2018 and increasing in 2020. When stratified by race/ethnicity, Whites (1931.7) had the highest AAMR, followed by Blacks (1836.5), American Indians (1510.5), Hispanics (1464.4), and Asians (1093.6). Furthermore, nonmetropolitan areas (2015.2) showed greater AAMRs than metropolitan areas (1841.8). The ≥ 85-year group consistently exhibited higher IHD-related mortality rates compared to the 75-84 years group. In comparison, the older group [≥75 years] (1873.0) consistently exhibited higher IHD-related AAMRs than the younger group [<75 years] (64.0) throughout the study, showing a significant disparity. Chronic IHD (1552.0) consistently showed the highest AAMRs throughout the study, surpassing myocardial infarction (515.6), other ischemic heart diseases (24.0), and angina pectoris (5.6).

CONCLUSION

Targeted interventions and resource allocation are crucial for areas with high IHD-related mortality. Public health policies should address demographic and geographical disparities, with further research for effective strategies.

Trends and Disparities in Parkinson's Disease Mortality in the United States with Predictions Using Machine Learning

BACKGROUND

Parkinson's disease (PD) is a progressive neurodegenerative condition characterized by the degradation of dopaminergic pathways in the brain. As the population in the United States continues to age, it is essential to understand the trends in mortality related to PD. This analysis of PD's mortality characterizes temporal shifts, examines demographic and regional differences, and provides machine-learning predictions.

METHODS

PD-related deaths in the United States were gathered from CDC WONDER. Age-adjusted mortality rates (AAMR) were collected, and trends were analyzed based on gender, race, region, age, and place of death. Annual percent change and average annual percent change were calculated using Joinpoint Regression program. Forecasts were obtained using the optimal Autoregressive Integrated Moving Average (ARIMA) model.

RESULTS

Overall mortality rate due to Parkinson's increased from 1999 to 2022. Male gender, White race, Southern region, and older ages were associated with higher mortality compared to other groups. Deaths at home decreased and hospice deaths increased during the study period.

CONCLUSIONS

This study highlights the increasing rate of PD AAMR and how it may become even more prevalent with time, emphasizing the value of increasing knowledge surrounding the disease and its trends to better prepare health systems and individual families for the burden of PD.

Heart Failure Mortality in Chronic Kidney Disease: The Fatal Crossover

BACKGROUND

Real-world mortality data regarding heart failure in patients with comorbid chronic kidney disease remains limited, especially following the advent of advanced heart failure therapies.

METHODS

Using the CDC WONDER database, we included patients ≥ 25 years old who died primarily from heart failure (2011-2020) with comorbid chronic kidney disease. We calculated age-adjusted mortality rates (AAMR) per 100,000 individuals. We determined the trends over time by estimating the annual percent change (APC) using the Joinpoint regression program.

RESULTS

There were 82,454 heart failure deaths with comorbid chronic kidney disease. The AAMR increased from 2.34 (95% CI, 2.28-2.41) in 2011 to 4.79 (95% CI, 4.71-4.88) in 2020. During the study period, Heart failure deaths among patients with comorbid chronic kidney disease increased by 149.0% compared to 59.9% in those without. Men had higher AAMR than women (3.92 [95% CI, 3.88-3.96] vs. 2.96 [95% CI, 2.93-2.99]). African American patients had the highest AAMR (5.85 [95% CI, 5.75-5.96]). The Midwest region had the highest AAMR (3.83 [95% CI, 3.78-3.89]). The AAMR was higher in the rural areas than in the urban regions (3.77 [95% CI, 3.71-3.83] vs. 3.23 [95% CI, 3.20-3.25]). Most patients died in hospices or nursing homes (29,000, 35.2%).

CONCLUSION

Our study showed a significant increase in heart failure AAMR in patients with comorbid chronic kidney disease in recent eras. Further effort is needed to optimize cardioprotective agents for this population and to address demographic discrepancies at the policy level.

Trends and disparities in heart failure-related mortality in the US adult population from 1999 to 2020

Introduction

The rising incidence of heart failure (HF) among the U.S. population has become a major concern for healthcare providers. This study aims to assess mortality trends related to HF across different age groups, racial demographics, and geographic locations from 1999 to 2020.

Material and methods

This descriptive analysis uses death certificate data from the CDC WONDER database to track mortality trends among HF patients from 1999 to 2020. Log-linear regression models were used to delineate trends. The study used deidentified public data, complying with ethical standards.

Results

Over 21 years, 1,426,657 HF-related deaths were recorded in individuals aged 15 and older, with a slight overall increase in mortality (AAPC = 0.11). Mississippi recorded the highest age-adjusted mortality rates (AAMRs) at 58.0 per 100,000. The Midwest showed the highest regional mortality rates, while the oldest individuals (≥ 85) exhibited the highest crude mortality rate (CMR) of 663.9. Males consistently demonstrated higher AAMRs than females, despite females accounting for 57.6% of the deaths. Black ancestry individuals experienced the highest mortality rates, with rising trends, particularly in non-metropolitan areas. After 2012, significant increases in mortality were noted, especially in individuals over 85, with stable rates in younger demographics.

Conclusions

Males and Black ancestry individuals are disproportionately affected, demonstrating the need for targeted interventions.

Unveiling End-of-Life Disparities in Chronic Rheumatic Heart Disease: A 22-Year Analysis of the CDC-WONDER Database

Background This research examines mortality patterns and the place of death in individuals with chronic rheumatic heart disease (RHD) in the United States, aiming to identify demographic predictors for home or hospice death. Additionally, the study aims to uncover trends in mortality due to RHD and provide a predictive forecast. Methods The study utilized data from the Centers for Disease Control and Prevention (CDC)-Wide-Ranging Online Data for Epidemiologic Research (WONDER) database, which spans 22 years (1999-2020), and was categorized based on place of death, including home or hospice care, inpatient, outpatient, or emergency room deaths, and nursing home facility deaths. The data was further analyzed by age, gender, race, and region. The Autoregressive Integrated Moving Average (ARIMA) model was used for statistical analysis and forecasting. Results A total of 73,673 deaths were analyzed, and age was found to be a significant predictor of place of death. The highest number of deaths was in the 85+ age group, followed by a decrease in likelihood with decreasing age. Individuals residing in the West were more likely to die at home or in hospice compared to those in other regions. White individuals had a higher likelihood of dying at home or in hospice compared to other racial groups. Conclusions The findings emphasize the importance of considering patients' preferences and ensuring equitable access to end-of-life care services, regardless of their demographic background. The study highlights the need for further research to improve access to palliative care, reduce disparities in end-of-life care, and enhance the quality of life for individuals with chronic RHD and their families.

The hidden epidemic: Hypertension-related mortality surges amongst younger adults in the United States

BACKGROUND

The prevalence of hypertension (HTN) has significantly increased among younger adults (15-45 yrs) in the U.S. Despite this, there is limited data on trends of HTN-related mortality within this population.

METHODS

Data from the CDC WONDER multiple-cause of death database was analyzed from 1999 to 2021, focusing on HTN-related mortality in young adults aged 15 to 45 years. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) were calculated and stratified by year, sex, race/ethnicity, urbanization status, and census region.

RESULTS

Between 1999 and 2021, there were 201,860 HTN-related deaths among young adults in the U.S. The AAMR increased from 2.8 in 1999 to 5.0 in 2001 (APC 35.3; 95 % CI 20.6 to 44.5) and then to 9.4 in 2019 (APC 3.1; 95 % CI 2.7 to 3.5) before sharply rising to 13.9 in 2021 (APC 22.3; 95 % CI 15.1 to 26.4). Men consistently exhibited higher AAMRs than women from 1999 (AAMR men: 3.6 vs women: 1.9) to 2021 (AAMR men: 18.9 vs women: 8.8). In 2020, the highest AAMR was observed among non-Hispanic (NH) Black or African American young adults (30.2), followed by NH American Indian/Alaska Natives (29.6), NH White (9.9), Hispanics or Latino (9.3) and NH Asian or Pacific Islander (5.0). The Southern region had the highest AAMR (9.3), followed by the Midwest (6.4), West (5.8), and Northeast (5.4). Nonmetropolitan areas consistently had higher AAMR (8.5) than metropolitan areas (7.0). States in the top 90 th percentile for AAMRs included Mississippi, the District of Columbia, Oklahoma, West Virginia, and Arkansas, with these states exhibiting approximately five times the AAMRs of those in the lower 10th percentile.

CONCLUSION

HTN-related mortality among young adults in the U.S. increased steadily until 2019, followed by a sharp rise in 2020 and 2021. The highest AAMRs were observed among men, NH Black young adults, and individuals residing in the Southern and non-metropolitan areas of the U.S. These findings underscore the need for targeted interventions to reduce the burden and address disparities in HTN-related mortality among young adults in the U.S.

Trends in cancer and heart failure related mortality in adult US population: A CDC WONDER database analysis from 1999 to 2020

BACKGROUND

With the advent of novel chemotherapy, survival of patients with cancer has improved. However, people with cancer have an increased risk of heart failure (HF). Conversely, HF-related mortality may undermine survival among people with cancer. We aim to analyze the trends of mortality in people with HF and cancer in the adult US population.

METHODS

We conducted an examination of death certificates sourced from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database, from the years 1999 to 2020. Mortality in adults with HF and cancer was assessed. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change were reported.

RESULTS

Between 1999 and 2020, 621,783 deaths occurred from HF in people with cancer. The AAMR declined from 16.4 in 1999 to 11.9 in 2017, after which an increase to 14.5 was observed in 2020. Men had consistently higher overall AAMR as compared to women (men = 18.1 vs women = 9.9). Similar AAMR was observed between non-Hispanic (NH) Blacks/African Americans (13.9) and NH Whites (13.3), with lower in American Indian/Alaska Native (9.6) and Hispanics (7.4). Asian/Pacific Islanders reported the lowest AAMR (5.7). The Midwestern region reported the highest AAMR (14.8). We observed the highest AAMR amongst the older population (61.4).

CONCLUSION

The mortality rates of people with HF and cancer are increasing in the adult U.S.

POPULATION

This underscores the need for increased screening, aggressive management, and subsequent surveillance of people at risk or with manifested HF in people with cancer.

Digital health as a tool for patient activation and improving quality of care for heart failure

The clinical and economic impact of heart failure (HF) is immense and will continue to rise due to the increasing prevalence of the disease. Despite the availability of guideline-recommended medications that improve mortality, reduce hospitalizations, and enhance quality of life, there are major gaps in the implementation of such care. Quality improvement interventions have generally focused on clinicians. While certain interventions have had modest success in improving the use of heart failure medications, they remain insufficient in optimizing HF care. Here, we discuss how patient-facing interventions can add value and supplement clinician-centered interventions. We discuss how digital health can be leveraged to create patient activation tools that create a larger, sustainable impact. Small studies have suggested the promise of digital tools for patient engagement and self-care, but there are also important barriers to the adoption of such interventions that we describe. We share key principles and strategies around the design and implementation of digital health innovations to maximize patient participation and engagement. By uniquely activating patients in their own care, digital health can unlock the full potential of both existing and new quality improvement initiatives to drive forward high-quality and equitable heart failure care.

Disparities in Heart Failure Deaths among Patients with Cirrhosis

Background: Heart failure deaths have increased in recent years in the United States and are projected to continue to increase in the future. Rates of liver disease and cirrhosis have similarly increased in the United States. Patients with cirrhosis are at an elevated risk of heart failure with a worsened prognosis. As such, investigations of the epidemiology of these comorbid conditions are important. Methods: We obtained data on heart failure deaths among people with cirrhosis in the United States from 1999 to 2020 from the Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research multiple cause of death database. Rates were analyzed for the population as a whole and for demographic subgroups. Results: From 1999 to 2020, there were 7424 cirrhosis-related heart failure deaths. Rates were higher among Black (AAMR ratio = 1.288, 95% CI: 1.282-1.295) and Asian people (AAMR ratio = 3.310, 95% CI: 3.297-3.323) compared to White people. Rates were also higher in rural areas than in urban areas (AAMR ratio = 1.266, 95% CI: 1.261-1.271). Rates increased over time across demographic subgroups. Conclusions: People with cirrhosis are at an elevated risk of heart failure death compared to the general population. Rates were particularly elevated in Asian people, Black people, males, and people living in rural areas. These data indicate a significant and previously underappreciated disease burden. Clinicians taking care of cirrhosis patients should be aware of the risk of heart failure and should collaborate with cardiac specialists as needed.

Impact of exercise training on clinical outcomes and quality of life in chronic congestive heart failure: A systematic review and meta-analysis

BACKGROUND

Exercise training is a well-established intervention for patients with heart failure with reduced and preserved ejection fraction. Still, the evidence of its effects on mortality, hospitalization, and quality of life needs to be more conclusive. We aim to evaluate exercise training clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).

METHODS

We searched five databases and three clinical trial registries for RCTs that compared exercise training plus usual care versus usual care alone in congestive heart failure (CHF) patients. We extracted data on all-cause mortality, hospital admission, heart failure hospitalization, and health-related quality of life measured by the Minnesota Living with HF questionnaire (MLHFW) and other scales. We pooled the data using random-effects or fixed-effects models, depending on the heterogeneity of the outcomes. We performed subgroup analyses for patients with heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).

RESULTS

We included 61 RCTs with 9062 participants. There was no mortality benefit, but exercise training improved health-related quality of life, reduced hospital admission at 12 months and longer follow-up, and reduced heart failure hospitalization. We observed substantial enhancement in health-related quality of life and a greater decrease in hospital admissions in the HFpEF group compared to the HFrEF group.

CONCLUSIONS

Despite the lack of mortality benefit, exercise training is a beneficial intervention for CHF patients, improving health-related quality of life and reducing hospitalization.

Global epidemiology of heart failure

Heart failure (HF) is a heterogeneous clinical syndrome marked by substantial morbidity and mortality. The natural history of HF is well established; however, epidemiological data are continually evolving owing to demographic shifts, advances in treatment and variations in access to health care. Although the incidence of HF has stabilized or declined in high-income countries over the past decade, its prevalence continues to increase, driven by an ageing population, an increase in risk factors, the effectiveness of novel therapies and improved survival. This rise in prevalence is increasingly noted among younger adults and is accompanied by a shift towards HF with preserved ejection fraction. However, disparities exist in our epidemiological understanding of HF burden and progression in low-income and middle-income countries owing to the lack of comprehensive data in these regions. Therefore, the current epidemiological landscape of HF highlights the need for periodic surveillance and resource allocation tailored to geographically vulnerable areas. In this Review, we highlight global trends in the burden of HF, focusing on the variations across the spectrum of left ventricular ejection fraction. We also discuss evolving population-based estimates of HF incidence and prevalence, the risk factors for and aetiologies of this disease, and outcomes in different geographical regions and populations.

Proactive approaches in congestive heart failure: the significance of early goals of care discussion and palliative care

Congestive Heart Failure (CHF) poses significant challenges to the healthcare system due to its high rates of morbidity and mortality as well as frequent readmissions. All of these factors contribute to increased healthcare delivery costs. Besides the burden on the healthcare system, CHF has far deeper effects on the patient in terms of psychological burden along with debilitating symptoms of dyspnea, all of which reduce quality of life. Prognostic awareness among patients about their disease along with initiating early goals of care discussion by those involved in the care (physicians, nurses, social worker and patient themselves) can help mitigate these challenges. Adopting a proactive approach to address patient preferences, values and end-of-life goals improves patient-centred care, enhances quality of life and reduces the strain on healthcare resources. In this narrative review, studies have been identified using PubMed search to shed knowledge on what is preventing the initiation of goals of care discussions. Some barriers include lack of knowledge about prognosis in both patients and caregivers, inexperience or discomfort in having those conversations and delaying it until CHF becomes too advanced.

Nrf2-Keap1 in Cardiovascular Disease: Which Is the Cart and Which the Horse?

High levels of oxidant stress in the form of reactive oxidant species are prevalent in the circulation and tissues in various types of cardiovascular disease including heart failure, hypertension, peripheral arterial disease, and stroke. Here we review the role of nuclear factor erythroid 2-related factor 2 (Nrf2), an important and widespread antioxidant and anti-inflammatory transcription factor that may contribute to the pathogenesis and maintenance of cardiovascular diseases. We review studies showing that downregulation of Nrf2 exacerbates heart failure, hypertension, and autonomic function. Finally, we discuss the potential for using Nrf2 modulation as a therapeutic strategy for cardiovascular diseases and autonomic dysfunction.

Contemporary pharmacological treatment and management of heart failure

The prevention and treatment strategies for heart failure (HF) have evolved in the past two decades. The stages of HF have been redefined, with recognition of the pre-HF state, which encompasses asymptomatic patients who have developed either structural or functional cardiac abnormalities or have elevated plasma levels of natriuretic peptides or cardiac troponin. The first-line treatment of patients with HF with reduced ejection fraction includes foundational therapies with angiotensin receptor-neprilysin inhibitors, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, β-blockers, mineralocorticoid receptor antagonists, sodium-glucose cotransporter 2 (SGLT2) inhibitors and diuretics. The first-line treatment of patients with HF with mildly reduced ejection fraction or with HF with preserved ejection fraction includes SGLT2 inhibitors and diuretics. The timely initiation of these disease-modifying therapies and the optimization of treatment are crucial in all patients with HF. Reassessment after initiation of these therapies is recommended to evaluate patient symptoms, health status and left ventricular function, and timely referral to a HF specialist is necessary if a patient has persistent advanced HF symptoms or worsening HF. Lifestyle modification and treatment of comorbidities such as diabetes mellitus, ischaemic heart disease and atrial fibrillation are crucial through each stage of HF. This Review provides an overview of the management strategies for HF according to disease stages that are derived from the recommendations in the latest US and European HF guidelines.

Trends in Mortality After Incident Hospitalization for Heart Failure Among Medicare Beneficiaries

Importance

Despite advances in treatment and care quality for patients hospitalized with heart failure (HF), minimal improvement in mortality has been observed after HF hospitalization since 2010.

Objective

To evaluate trends in mortality rates across specific intervals after hospitalization.

Design, Setting, and Participants

This cohort study evaluated a random sample of Medicare fee-for-service beneficiaries with incident HF hospitalization from January 1, 2008, to December 31, 2018. Data were analyzed from February 2023 to May 2024.

Main Outcomes and Measures

Unadjusted mortality rates were calculated by dividing the number of all-cause deaths by the number of patients with incident HF hospitalization for the following periods: in-hospital, 30 days (0-30 days after hospital discharge), short term (31 days to 1 year after discharge), intermediate term (1-2 years after discharge), and long term (2-3 years after discharge). Each period was considered separately (ie, patients who died during one period were not counted in subsequent periods). Annual unadjusted and risk-adjusted mortality ratios were calculated (using logistic regression to account for differences in patient characteristics), defined as observed mortality divided by expected mortality based on 2008 rates.

Results

A total of 1 256 041 patients (mean [SD] age, 83.0 [7.6] years; 56.0% female; 86.0% White) were hospitalized with incident HF. There was a substantial decrease in the mortality ratio for the in-hospital period (unadjusted ratio, 0.77; 95% CI, 0.67-0.77; risk-adjusted ratio, 0.74; 95% CI, 0.71-0.76). For subsequent periods, mortality ratios increased through 2013 and then decreased through 2018, resulting in no reductions in unadjusted postdischarge mortality during the full study period (30-day mortality ratio, 0.94; 95% CI, 0.82-1.06; short-term mortality ratio, 1.02; 95% CI, 0.87-1.17; intermediate-term mortality ratio, 0.99; 95% CI, 0.79-1.19; and long-term mortality ratio, 0.96; 95% CI, 0.76-1.16) and small reductions in risk-adjusted postdischarge mortality during the full study period (30-day mortality ratio, 0.88; 95% CI, 0.86-0.90; short-term mortality ratio, 0.94; 95% CI, 0.94-0.95; intermediate-term mortality ratio, 0.94; 95% CI, 0.92-0.95; and long-term mortality ratio, 0.95; 95% CI, 0.93-0.96).

Conclusions and Relevance

In this study of Medicare fee-for-service beneficiaries, there was a substantial decrease in in-hospital mortality for patients hospitalized with incident HF from 2008 to 2018, but little to no reduction in mortality for subsequent periods up to 3 years after hospitalization. These results suggest opportunities to improve longitudinal outpatient care for patients with HF after hospital discharge.

Comparative effectiveness of myocardial patches and intramyocardial injections in treating myocardial infarction with a MitoQ/hydrogel system

In cardiac tissue engineering, myocardial surface patches and hydrogel intramyocardial injections represent the two primary hydrogel-based strategies for myocardial infarction (MI) treatment. However, the comparative effectiveness of these two treatments remains uncertain. Therefore, this study aimed to compare the effects of the two treatment modalities by designing a simple and reproducible hydrogel cross-linked with γ-PGA and 4-arm-PEG-SG. To improve mitochondrial damage in cardiomyocytes (CMs) during early MI, we incorporated the mitochondria-targeting antioxidant MitoQ into the hydrogel network. The hydrogel exhibited excellent biodegradability, biocompatibility, adhesion, and injectability in vitro. The hydrogel was utilized for rat MI treatment through both patch adhesion and intramyocardial injections. In vivo results demonstrated that the slow release of MitoQ peptide from the hydrogel hindered ROS production in CM, alleviated mitochondrial damage, and enhanced CM activity within 7 days, effectively inhibiting MI progression. Both hydrogel intramyocardial injections and patches exhibited positive therapeutic effects, with intramyocardial injections demonstrating superior efficacy in terms of cardiac function and structure in equivalent treatment cycles. In conclusion, we developed a MitoQ/hydrogel system that is easily prepared and can serve as both a myocardial patch and an intramyocardial injection for MI treatment, showing significant potential for clinical applications.

Diversity in research on aging: A new series

This editorial comments on the article by Gilmore et al.

Demographic trends of cardiorenal and heart failure deaths in the United States, 2011-2020

BACKGROUND

Heart failure (HF) and kidney disease frequently co-occur, increasing mortality risk. The cardiorenal syndrome results from damage to either the heart or kidney impacting the other organ. The epidemiology of cardiorenal syndrome among the general population is incompletely characterized and despite shared risk factors with HF, differences in mortality risk across key demographics have not been well described. Thus, the primary goal of this study was to analyze annual trends in cardiorenal-related mortality, evaluate if these trends differed by age, sex, and race or ethnicity, and describe these trends against a backdrop of HF mortality.

METHODS AND FINDINGS

The Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research database was used to examine cardiorenal- and HF-related mortality in the US between 2011and 2020. International Classification of Diseases, 10 Revision codes were used to classify cardiorenal-related deaths (I13.x) and HF-related deaths (I11.0, I13.0, I13.2, and I50.x), among decedents aged 15 years or older. Decedents were further stratified by age group, sex, race, or ethnicity. Crude and age-adjusted mortality rates (AAMR) per 100,000 persons were calculated. A total of 97,135 cardiorenal-related deaths and 3,453,655 HF-related deaths occurred. Cardiorenal-related mortality (AAMR, 3.26; 95% CI: 3.23-3.28) was significantly lower than HF-related mortality (AAMR, 115.7; 95% CI: 115.6-115.8). The annual percent change (APC) was greater and increased over time for cardiorenal-related mortality (2011-2015: APC, 7.1%; 95% CI: 0.7-13.9%; 2015-2020: APC, 19.7%, 95% CI: 16.3-23.2%), whereas HF-related mortality also increased over that time period, but at a consistently lower rate (2011-2020: APC, 2.4%; 95% CI: 1.7-3.1%). Mortality was highest among older and male decedents for both causes. Cardiorenal-related deaths were more common in non-Hispanic or Latino Blacks compared to Whites, but similar rates were observed for HF-related mortality. A larger proportion of cardiorenal-related deaths, compared to HF-related deaths, listed cardiorenal syndrome as the underlying cause of death (67.0% vs. 1.2%).

CONCLUSIONS

HF-related deaths substantially outnumber cardiorenal-related deaths; however, cardiorenal-related deaths are increasing at an alarming rate with the highest burden among non-Hispanic or Latino Blacks. Continued surveillance of cardiorenal-related mortality trends is critical and future studies that contain detailed biomarker and social determinants of health information are needed to identify mechanisms underlying differences in mortality trends.

Heart Failure-Related Death in Subjects With Atrial Fibrillation in the United States, 1999 to 2020

BACKGROUND

Population-based data on heart failure (HF)-related death in patients with atrial fibrillation (AF) are lacking. We assessed HF-related death in people with AF in the United States over the past 21 years and examined differences by age, sex, race, ethnicity, urbanization, and census region.

METHODS AND RESULTS

Data were extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research to determine trends in age-adjusted mortality rates per 100 000 people, due to HF-related death among subjects with AF aged ≥15 years. To calculate nationwide annual trends, we assessed the average annual percent change (AAPC) and annual percent change with relative 95% CIs using joinpoint regression. Between 1999 and 2020, 916 685 HF-related deaths (396 205 men and 520 480 women) occurred among US adults having a concomitant AF. The overall age-adjusted mortality rates increased (AAPC: +4.1% [95% CI, 3.8-4.4]; P<0.001), especially after 2011 (annual percent change, +6.8% [95% CI, 6.2-7.4]; P<0.001) in men (AAPC, +4.8% [95% CI, 4.4-5.1]; P<0.001), in White subjects (AAPC: +4.2% [95% CI, 3.9 to 4.6]; P<0.001) and in subjects aged <65 years (AAPC: +7.5% [95% CI, 6.7-8.4]; P<0.001). The higher percentage of deaths were registered in the South (32.8%). During the first year of the COVID-19 pandemic, a significant excess in HF-related deaths among patients with AF aged >65 years was observed.

CONCLUSIONS

A worrying increase in the HF-related mortality rate among patients with AF has been observed in the United States over the past 2 decades.

Mortality patterns in older adults with infective endocarditis in the US: A retrospective analysis

BACKGROUND

Infective Endocarditis (IE) has become a significant cause of morbidity and mortality over the last two decades. Despite management advancements, mortality trends in the USA's geriatric population are unexplored. The aim of this study was to assess the trends and regional differences in IE related mortality among geriatric patients in the USA.

METHODS

We analyzed death certificates sourced from the CDC WONDER database spanning 1999 to 2020. The research targeted individuals aged 65 and older. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent change (APC), along with 95% CI, were calculated through joinpoint regression analysis.

RESULTS

From 1999 to 2020, infective endocarditis caused 222,573 deaths, showing a declining trend (APC: -0.8361). Males had higher AAMR (26.8) than females (22.2). NH White had the highest AAMR (25.8), followed by NH American Indians or Alaska Natives (19.6). Geographically, the Midwest had the highest AAMR (27.4), followed by the Northeast (25.8). Rural areas consistently had higher AAMRs (26.6) than urban areas (23.6), while 80.16% of deaths occurring in urban settings. North Dakota, Nebraska, and Montana had the highest state AAMRs, approximately double than the states with the lowest mortality rates: Mississippi, Hawaii, California, and Massachusetts. Those aged 85 and above accounted for 42.9% of deaths.

CONCLUSION

IE mortality exhibited a clear pattern: rising till 2004, declining from 2004 to 2018, and increasing again till 2020. Key risk factors were male gender, Midwest residence, NH White ethnicity, and age ≥85.Targeted interventions are essential to reduce IE mortality, especially among vulnerable older populations.

Impact of Frailty on Heart Failure Prognosis: Is Sex Relevant?

PURPOSE OF REVIEW

Heart failure (HF) is one of the most frequent causes of hospital admission in elderly patients, especially in women, who present a high prevalence of geriatric syndromes like frailty. Studies have suggested that frailty and its impact may also differ between males and females. Understanding how frailty may differently affect HF patients depending on sex is therefore imperative for providing personalized care. The aim of this review is to summarize the role of sex in the prognostic impact of frailty in HF patients.

RECENT FINDINGS

Numerous studies have identified frailty as a significant predictor of all-cause mortality and hospital readmissions. A recent study of elderly HF out-patients demonstrated that while women had a higher prevalence of frailty, it was an independent predictor of mortality and readmission only in men. Moreover, another study revealed that physical frailty was associated with time to first clinical event among men but not among women. These results raise the question about why frailty affects differently HF prognosis in men and women. Women with HF present a higher prevalence of frailty, especially when it is considered as physical decline. Nevertheless, frailty affects differently HF prognosis in men and women. Women with HF present lower mortality than men and frailty is related with prognosis only in men. The different severity of HF between men and women and other hormonal, psychosocial, and clinical factors might be involved in this fact.

Trends in mortality from gastrointestinal, hepatic, and pancreatic cancers in the United States: A comprehensive analysis (1999-2020)

Background and Aim

This study investigates temporal trends in gastrointestinal cancer-related mortality in the United States between 1999 and 2020, focusing on differences by sex, age, and race.

Methods

We investigated the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research multiple causes of death database (Years 1999-2020) for gastrointestinal cancer-related mortality with a focus on the underlying cause of death.

Results

A total of 3 115 243 gastrointestinal cancer-related deaths occurred from 1999 to 2020. The overall age-adjusted mortality rate decreased from 46.7 per 100 000 in 1999 to 38.4 per 100 000 in 2020. The average annual percent change (AAPC) for the study period was -0.9% (95% CI: -1.0%, -0.9%, P < 0.001), with no significant difference in AAPC between the sexes but some difference between races and related to individual cancers. African Americans and Asian Americans, and Pacific Islanders experienced a greater decrease in mortality compared with Whites. Mortality rates for American Indian and Alaskan Native populations also decreased significantly from 1999 to 2020 (P < 0.001). There were significant declines in esophageal, stomach, colon, rectal, and gallbladder cancer-related mortality but increases in the small bowel, anal, pancreatic, and hepatic cancer-related mortality (P < 0.001), with variation across different sexes and racial groups.

Conclusion

While overall gastrointestinal cancer-related mortality declined significantly in the United States from 1999 to 2020, mortality from some cancers increased. Furthermore, differences between sexes and racial groups underscore crucial differences in gastrointestinal cancer mortality, highlighting areas for future research.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Trends in sleep apnea and heart failure related mortality in the United States from 1999 to 2019

National estimates of deaths related to both heart failure (HF) and sleep apnea (SA) are not known. We evaluated the trends in HF and SA related mortality using the CDC-WONDER database in adults aged ≥25 years in the US. All deaths related to HF and SA as contributing or underlying causes of death were queried. Between 1999 and 2019, there were a total of 6,484,486 deaths related to HF, 204,824 deaths related to SA, and 53,957 deaths related to both. There was a statistically significant increase in the age-adjusted mortality rate (AAMR) for both SA-related (average annual percent change [AAPC] 8.2%) and combined HF and SA- related (AAPC 10.1 %) deaths. Men had consistently higher AAMRs compared with women, and both groups had a similar increasing trend in AAMR. Non-Hispanic (NH) Black individuals had the highest HF and SA-related AAMR, followed by NH White and Hispanic/Latino individuals. Adults aged >75 years consistently had the highest AAMR with the steepest increase (AAPC 11.1%). In conclusion, HF and SA-related mortality has significantly risen over the past two decades with the elderly, men, and NH Black at disproportionately higher risk.

Exploring Heart Failure Mortality Trends and Disparities in Women: A Retrospective Cohort Analysis

Heart failure (HF) remains a significant cause of morbidity and mortality in women. Population-level analyses shed light on existing disparities and promote targeted interventions. We evaluated HF-related mortality data in women in the United States to identify disparities based on race/ethnicity, urbanization level, and geographic region. We conducted a retrospective cohort analysis utilizing the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database to identify HF-related mortality in the death files from 1999 to 2020. Age-adjusted HF mortality rates were standardized to the 2000 US population. We fit log-linear regression models to analyze mortality trends. Age-adjusted HF mortality rates in women have decreased significantly over time, from 97.95 in 1999 to 89.19 in 2020. Mortality mainly downtrended from 1999 to 2012, followed by a significant increase from 2012 to 2020. Our findings revealed disparities in mortality rates based on race and ethnicity, with the most affected population being non-Hispanic Black (age-adjusted mortality rates [AAMR] 90.36), followed by non-Hispanic White (AAMR 83.25), American Indian/Alaska Native (AAMR 64.27), and Asian/Pacific Islander populations (AAMR 37.46). We also observed that nonmetropolitan (AAMR 103.36) and Midwestern (AAMR 90.45) regions had higher age-adjusted mortality rates compared with metropolitan (AAMR 78.43) regions and other US census regions. In conclusion, significant differences in HF mortality rates were observed based on race/ethnicity, urbanization level, and geographic region. Disparities in HF outcomes persist and efforts to reduce HF-related mortality rates should focus on targeted interventions that address social determinants of health, including access to care and socioeconomic status.

Regional variations in heart failure: a global perspective

Heart failure (HF) is a global public health concern that affects millions of people worldwide. While there have been significant therapeutic advancements in HF over the last few decades, there remain major disparities in risk factors, treatment patterns and outcomes across race, ethnicity, socioeconomic status, country and region. Recent research has provided insight into many of these disparities, but there remain large gaps in our understanding of worldwide variations in HF care. Although the majority of the global population resides across Asia, Africa and South America, these regions remain poorly represented in epidemiological studies and HF trials. Recent efforts and registries have provided insight into the clinical profiles and outcomes across HF patterns globally. The prevalence of HF and associated risk factors has been reported and varies by country and region ranges, with minimal data on regional variations in treatment patterns and long-term outcomes. It is critical to improve our understanding of the different factors that contribute to global disparities in HF care so we can build interventions that improve our general cardiovascular health and mitigate the social and economic cost of HF. In this narrative review, we hope to provide an overview of the global and regional variations in HF care and outcomes.

Differences in predictors of incident heart failure according to atherosclerotic cardiovascular disease status

AIMS

Heart failure (HF) is a common cause of morbidity and mortality, related to a broad range of sociodemographic, lifestyle, cardiometabolic, and comorbidity risk factors, which may differ according to the presence of atherosclerotic cardiovascular disease (ASCVD). We assessed the association between incident HF with baseline status across these domains, overall and separated according to ASCVD status.

METHODS AND RESULTS

We included 5758 participants from the Baker Biobank cohort without HF at baseline enrolled between January 2000 and December 2011. The primary endpoint was incident HF, defined as hospital admission or HF-related death, determined through linkage with state-wide administrative databases (median follow-up 12.2 years). Regression models were fitted adjusted for sociodemographic variables, alcohol intake, smoking status, measures of adiposity, cardiometabolic profile measures, and individual comorbidities. During 65 987 person-years (median age 59 years, 38% women), incident HF occurred among 784 participants (13.6%) overall. Rates of incident HF were higher among patients with ASCVD (624/1929, 32.4%) compared with those without ASCVD (160/3829, 4.2%). Incident HF was associated with age, socio-economic status, alcohol intake, smoking status, body mass index (BMI), waist circumference, waist-hip ratio, systolic blood pressure (SBP), and low- and high-density lipoprotein cholesterol (LDL-C and HDL-C), with non-linear relationships observed for age, alcohol intake, BMI, waist circumference, waist-hip ratio, SBP, LDL-C, and HDL-C. Risk factors for incident HF were largely consistent regardless of ASCVD status, although diabetes status had a greater association with incident HF among patients without ASCVD.

CONCLUSIONS

Incident HF is associated with a broad range of baseline sociodemographic, lifestyle, cardiometabolic, and comorbidity factors, which are mostly consistent regardless of ASCVD status. These data could be useful in efforts towards developing risk prediction models that can be used in patients with ASCVD.

Temporal Trends in Heart Failure Management and Outcomes: Insights From a Japanese Multicenter Registry of Tertiary Care Centers

Background The management of heart failure (HF) has markedly changed, due to changes in demographics and the emergence of novel pharmacotherapies. However, detailed analyses on the temporal trends in characteristics and outcomes among patients with HF are scarcely available. This study aimed to assess the temporal trends over 11 years in clinical management and outcomes in patients with HF. Methods and Results We analyzed data from a multicenter registry of hospitalized patients with acute HF, including 6877 patients registered from 2011 to 2021. Age-adjusted mortality was calculated using standardized mortality ratios. During the study period, mean age increased from 75.2 years in 2011 to 2012 to 76.4 years in 2020 to 2021 (P for trend <0.001). The proportion of HF with reduced ejection fraction (HFrEF, left ventricular ejection fraction <40%) remained constant (from 43.4% to 42.7%, P for trend=0.38). The median duration of hospital stays (from 15 to 17 days, P for trend<0.001) had increased. As for the implementation of guideline-directed medical therapy, the use of mineralocorticoid receptor antagonist at discharge increased in patients with HFrEF (from 44.3% to 60.2%, P for trend<0.001). There was also an increase in the use of sodium-glucose cotransporter-2 inhibitors following their approval for use. The age-adjusted 1-year mortality decreased in patients with HFrEF (from 18.0% to 9.3%, P for trend<0.001) but not in patients with non-HFrEF (left ventricular ejection fraction ≥40%; from 9.2% to 9.5%, P for trend=0.79). Conclusions Hospitalized patients with HF have been aging over the past decade. Their long-term outcomes after discharge have improved predominantly because of decreased mortality in patients with HFrEF.