Trends in heart failure-related mortality among middle-aged adults in the United States from 1999-2022

Introduction

Heart failure (HF) represents a significant contributor to morbidity and mortality. Heart failure mortality trends among the middle aged have not been fully characterized into the years of the COVID-19 pandemic. Our objective was to analyze the trends in mortality related to heart failure across various demographic and geographic categories—including gender, race, and census region—spanning from 1999 to 2022, with particular attention paid to the effect of the COVID-19 pandemic on HF mortality.

Methods

Heart failure-related mortality data were extracted from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database and stratified into different demographic and geographic groups. Statistically significant trends in mortality over time were identified using Joinpoint regression.

Results

Heart failure mortality decreased among most studied demographic groups from 1999 to 2011-2013, then increased through 2022, often with a marked increase in mortality in the pandemic years of 2020-2022. Males, Black or African Americans, and the South generally had higher mortality rates than their demographic or geographic counterparts. Existing disparities between high-risk groups and others generally worsened during the pandemic.

Conclusion

The COVID-19 pandemic accelerated a decade of heart failure mortality increases, and in some categories worsened existing disparities. This is likely due to reduced access to healthcare during the pandemic, along with a direct increase in mortality from heart failure caused by COVID-19.