Trends and Disparities in Acute Myocardial Infarction Mortality Among U.S. Adults With Heart Failure, 1999–2024
Abstract Body (Do not enter title and authors here): Background Acute myocardial infarction (AMI) frequently complicates heart failure, yet national mortality trends in this population remain incompletely characterized. Understanding temporal patterns and disparities can guide targeted prevention strategies. Hypothesis We hypothesized that AMI-related mortality among U.S. adults with heart failure declined from 1999 to 2012, rose during 2018–2021, and that significant disparities exist by sex, race/ethnicity, geography, and urbanization. Methods We analyzed CDC WONDER cause-of-death data (1999–2024) for U.S. decedents aged ≥25 years with heart failure (ICD-10 I50x) and AMI (ICD-10 I21x). We calculated the total number of deaths, the proportions by place, and the annual age-adjusted mortality rates (AAMRs) per 100,000 population. Joinpoint regression estimated average annual percent change (AAPC) in AAMR. Analyses were stratified by sex, race/ethnicity, Census region, and urban/rural status. Results From 1999 to 2024, there were 562,454 deaths related to AMI among adults suffering from heart failure. The locations of death were as follows: 57.9% occurred in medical facilities, while 21.4% occurred at home. The overall AAMR declined from 15.3 in 1999 to 8.1 in 2024, noted as an AAPC of –2.71 (p < 0.001). Significant segmented declines were observed from 1999 to 2012, followed by a period of stability from 2012 to 2018, an increase from 2018 to 2021, and a subsequent decline from 2021 to 2024 (all p < 0.05). Men exhibited a higher AAMR compared to women, with rates of 12.5 and 8.0, respectively, reflecting the overall trend. By racial demographics, the AAMRs were highest among Non-Hispanic Black individuals (10.9), followed by Non-Hispanic White individuals (10.1). Notably, Non-Hispanic Black individuals demonstrated the largest increase from 2018 to 2021 (p < 0.05). The Southern region reported the highest mean AAMR at 10.7, in contrast to the Northeast, which had a mean rate of 8.4. In 2020, the AAMR in rural areas (13.5) surpassed that of urban areas (7.4). Additionally, state-specific AAMRs ranged from 23.4 in Arkansas to 5.2 in Nevada. Conclusions AMI-related mortality in U.S. adults with heart failure sharply declined until 2012, plateaued, surged during 2018–2021, then declined again. Disparities by sex, race/ethnicity, region, and rurality underscore the need for targeted interventions for high-risk groups, especially NH Black adults and residents in Southern and rural areas.
Naveed, Hamza
( Queen Elizabeth the Queen Mother Hospital, EKHUFT, Margate.
, Kent.
, United Kingdom
)
Ahmed, Mushood
( Rawalpindi Medical University
, Bhimber
, Pakistan
)
Neppala, Sivaram
( University of Texas Health SA
, Boerne
, Texas
, United States
)
Umar, Muhammad
( Khairpur medical college
, Khairpur
, Pakistan
)
Omer Rehan, Muhammad
( Dow Medical College, DUHS
, Karachi
, Pakistan
)
Naveed, Muhammad Abdullah
( Dow Medical College, DUHS
, Karachi
, Pakistan
)
Wani, Shariq Ahmad
( Government Medical college Srinagar
, Srinagar
, India
)
Kashan, Muhammad
( Dow Medical College, DUHS
, Karachi
, Pakistan
)
Soni, Kriti
( SUNY Upstate Medical University
, New York
, New York
, United States
)
Ali, Hamza
( Shaheed Mohtarma Benazir Bhutto Medical College Lyari
, Karachi
, Sindh
, Pakistan
)
Author Disclosures:
Hamza Naveed:DO NOT have relevant financial relationships
| Mushood Ahmed:DO NOT have relevant financial relationships
| Sivaram Neppala:DO NOT have relevant financial relationships
| Muhammad Umar:No Answer
| Muhammad Omer Rehan:DO NOT have relevant financial relationships
| Muhammad Abdullah Naveed:DO NOT have relevant financial relationships
| Shariq Ahmad Wani:DO NOT have relevant financial relationships
| Manahil Mubeen:DO NOT have relevant financial relationships
| Fahad Masood:DO NOT have relevant financial relationships
| Muhammad Kashan:No Answer
| Kriti Soni:DO NOT have relevant financial relationships
| Hamza Ali:No Answer
