Abstract Body (Do not enter title and authors here): Background
The prevalence of obesity has been increasing over the past decades. While heart failure (HF) and obesity management evolve, real-world data on their population-level mortality benefits is lacking.

Objective
Our study aimed to assess the HF and cardiomyopathy-related mortality trends among patients with obesity in the United States (U.S.) and disparities across demographics.

Methods
We queried the CDC WONDER database among adults aged ≥ 25 from 1999 to 2019. We included patients in whom HF and cardiomyopathy were listed as the main cause of death, with obesity as a contributing cause of death. We calculated age-adjusted mortality rates (AAMR) per 100,000 individuals. We determined trends over time by estimating the annual percent change (APC) using the Joinpoint regression program. We evaluated the social vulnerability of U.S. counties (2014-2018) using the CDC/ATSDR SVI database.

Results
There were 29,334 deaths related to HF and cardiomyopathy among patients with comorbid obesity. The overall AAMR increased from 0.41 (95% CI, 0.38-0.44) in 1999 to 0.94 (95% CI, 0.90-0.98) in 2019, with an APC of 3.78 (95% CI, 3.41-4.14, P<0.01). The percentage increase in the crude mortality rate of HF and cardiomyopathy among individuals with comorbid obesity was greater than that among those without comorbid obesity. Males had a higher AAMR than females (0.78 [95% CI, 0.77-0.79] vs 0.55 [95% CI, 0.54-0.56]). African Americans also had higher AAMR than Whites (1.35 [95% CI, 1.32-1.39] vs 0.62 [95% CI, 0.61-0.63]). The AAMR was higher in rural areas than in urban regions (0.76 [95% CI, 0.74-0.78] vs 0.66 [95% CI, 0.65-0.67]). The overall AAMR was higher in counties with social vulnerability index-Q4 (SVI-Q4) (most vulnerable) (1.08 [95% CI: 1.04-1.12]) compared to SVI-Q1 (least vulnerable) (0.63 [95% CI: 0.60-0.66]) with a risk ratio of 1.71 (95% CI: 1.61-1.83).

Conclusion
Our study reveals the rising trend of HF and cardiomyopathy mortality in individuals with comorbid obesity. Males, African Americans, and individuals from rural regions had higher AAMR than their counterparts. This warrants the formulation of targeted healthcare policies for this vulnerable group.