Abstract Body (Do not enter title and authors here): Background: Cardiac amyloidosis, often unrecognized, presents a significant mortality risk when complicated by heart failure (HF). Disparities in amyloid-related outcomes have been previously identified.
Question: What are the mortality trends and disparities associated with amyloidosis and HF in the United States (US) from 1999 to 2020?
Methods: Mortality due to amyloid and HF as contributors of death were queried from death certificates within the CDC database during 1999 to 2020. Age-adjusted mortality rates (AAMR) per 100,000 population and 95% confidence intervals were compared by race and ethnicity. Log-linear regression models were utilized to assess temporal variation (annual percentage change [APC]) in mortality.
Results: Between 1999 and 2020, there were 9,526 deaths related to HF and amyloidosis, with AAMR rising from 0.09 in 1999 to 0.27 in 2020. While HF-AAMR in general population declined slightly from 1999 to 2020 (average APC -0.4%, p=0.003), HF-related mortality in amyloidosis increased gradually from 1999 to 2013 (APC +1.4%, p=0.048), then accelerated from 2013 to 2020 (APC +13.3%, p<0.001). AAMR was higher in urban (AAMR 0.14) than rural regions (AAMR 0.11), among males (AAMR 0.20) than females (AAMR 0.07). Mortality increased steadily in males from 1999 to 2013 (APC +0.8%, p=0.003) with an accelerating inflection in 2013 to 2020 (APC +13.8%, p<0.001). Mortality in females remained stagnant from 1999 to 2013 (APC -1.0%, p=0.300) followed by an increase from 2013 to 2020 (APC +10.8%, p<0.001). Mortality was highest in Black populations (AAMR 0.33), followed by White (AAMR 0.10), Asian/Pacific (AAMR 0.06), and American Indian populations (AAMR 0.04). Mortality among Black populations remained consistent from 1999 to 2012 (APC +1.1%, p=0.184) followed by an increase from 2012 to 2020 (APC +14.0%, p<0.001). Among White populations, mortality remained stagnant from 1999 to 2013 (APC +0.7%, p=0.302) followed by an increase in mortality starting in 2013 to 2020 (APC +13.5%, p<0.001).
Conclusion: Amyloid and HF related mortality increased in the recent 22-year period, primarily starting in 2013. This is likely a result of increased awareness and availability of novel diagnostic testing like Tc-PYP.