Temporal Trends in Mortality Due to Ischemic Heart Disease and Cardiac Arrhythmias in the United States From 1999 to 2023

Abstract

Background

Ischemic heart disease (IHD) remains a leading cause of mortality in the United States, while arrhythmia-related deaths are increasing. However, long-term mortality trends involving both conditions remain unclear.

Methods

We utilized the CDC WONDER Multiple Cause-of-Death database to obtain records from 1999 to 2023, targeting US adults aged ≥ 25 years. Deaths involving IHD and arrhythmias were assessed. Age-adjusted mortality rates (AAMR) were calculated and stratified by gender, age, ethnicity, census region, and urbanization.

Results

A total of 1 795 918 deaths were attributed to both IHD and cardiac arrhythmias between 1999 and 2023. The AAMR declined from 41.97 (95% CI: 41.66−42.27) in 1999 to 32.73 (95% CI: 32.51−32.94) in 2023, representing an overall decrease of 22% (AAPC −0.99). Men had higher AAMRs compared to women (45.0 [95% CI: 44.6−45.5] vs. 23.4 [95% CI: 23.2−23.7]). The highest mortality rate was observed among NH White individuals (AAMR: 34.8; 95% CI: 34.5−35.0), while the lowest was among NH Asian or Pacific Islanders (AAMR: 16.5; 95% CI: 15.6−17.5). Older adults exhibited the higher AAMRs (144.74; 95% CI: 143.60−145.88) compared to younger cohorts. An increased death burden was observed in non-metropolitan (AAMR: 37.1; 95% CI: 36.5−37.8) and Midwest regions (35.5; 95% CI: 34.9−36.0). The majority of the deaths occurred in inpatient facilities (34.7%).

Conclusions

Although IHD–arrhythmia mortality declined between 1999 and 2023, substantial disparities persisted across demographic and geographic subgroups, highlighting the need for targeted public health interventions.