Heart Failure-related Mortality Before And During The Covid-19 Pandemic: A Cross-sectional Analysis Of A National Database

Abstract

Background

Heart failure (HF) with comorbid COVID-19 infection has worse outcomes. We compared HF mortality trends during the COVID-19 pandemic to the pre-pandemic period.

Methods

We used data from the Centers for Disease Control Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) database to identify trends in HF mortality in the pre-pandemic period (1999-2019) to the COVID-19 pandemic period (2020-2021). The following ICD-10 codes were used to find relevant data: I11.0, I13.0, I13.2, and I50. All deaths related to HF in adults aged ≥25 years were included. Age-adjusted mortality rates (AAMR) per 100,000 people were calculated and stratified by gender, race, census region, and age. Annual percentage change (APC) was calculated using the Joinpoint regression software.

Results

A total of 7,366,944 deaths occurred due to HF in adults aged ≥25 years from 1999 to 2021 (Table 1). The overall AAMR showed a decline prior to the COVID-19 pandemic (AAMR: 143.9; APC: -0.63 [-0.73 to -0.47]), followed by a sharp rise during the pandemic (AAMR: 167.8; APC: 7.91 [5.71 to 9.42]). Compared to women, men had a consistently higher AAMR before (AAMR men: 167.4 vs. women: 127.1) and during the pandemic (AAMR men: 200.4 vs. women: 142.6). Stratified by race/ethnicity, non-Hispanic (NH) Blacks showed a consistently higher AAMR before (AAMR NH Blacks: 157.3 vs. NH White: 150 vs. NH American Indian or Alaska Native: 135.7 vs. Hispanic: 94.6 vs. NH Asian or Pacific Islander: 65.5) and during the pandemic (AAMR NH Blacks: 200.4 vs. NH White: 175.4 vs. NH American Indian or Alaska Native: 168.4 vs. Hispanic: 112.4 vs. NH Asian or Pacific Islander: 70.4). Older adults (age ≥65 years) had the highest AAMR before (AAMR >65 years: 673 vs. 45-64 years: 31.4 vs. 25-44 years: 3.4) and during the pandemic (AAMR >65 years: 757.9 vs. 45-64 years: 49.2 vs. 25-44 years: 6.1). Moreover, when stratified by census regions, Midwestern region showed the highest AAMR, followed by the Southern, Western, and Northeastern regions in the before and during the pandemic period. During the pandemic, the rise in mortality (APC) was greater in younger and middle-aged adults compared with the elderly.

Conclusion

After more than two decades of consistent decline in HF-related mortality, a sharp surge in AAMR coinciding with the COVID-19 pandemic has been observed. HF mortality was greater in the pandemic period across all demographic groups; however, the rate of increase was greater in younger and middle-aged adults compared with the elderly.