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.