Abstract Body (Do not enter title and authors here): Background: Coronary artery disease (CAD), a leading cause of mortality in the United States, often leads to cardiac arrest. However, their combined mortality outcomes have not been studied yet. This study aims to analyze the mortality trends among adults with CAD and cardiac arrest in the United States from 1999 to 2023.

Methods: Death certificates of adults aged ≥ 25 from the CDC WONDER database were assessed, using ICD-10 codes: I25 (CAD) and I46 (cardiac arrest). Age-adjusted mortality rates (AAMRs) per 1 million individuals were stratified by sex, year, age group, race/ethnicity, census region, and urbanization. We utilized the Joinpoint software to extract annual percent changes (APCs) and average APCs (AAPCs) with 95% confidence intervals (CIs), and statistical significance was set at p <0.05.

Results: A total of 2,336,131 deaths from CAD and cardiac arrest occurred among adults aged ≥ 25. The overall AAMR decreased significantly with an AAPC of -4.04 (95% CI: -4.54 to -3.54; p <0.000001). Men exhibited a lower rate of decline (AAPC: -3.59; 95% CI: -4.12 to -3.05; p <0.000001) than women (AAPC: -4.75; 95% CI: -5.42 to -4.07; p <0.000001). By race, Hispanics showed the highest rate of decrease (AAPC: -5.12; 95% CI: -6.07 to -4.15; p <0.000001), and non-Hispanic (NH) American Indians had the lowest (AAPC: -2.75; 95% CI: -3.60 to -1.89; p <0.000001). By region, the greatest rate of decline was seen in the South (AAPC: -4.53; 95% CI: -5.17 to -3.88; p <0.000001). Compared to non-metropolitan areas, which showed an AAPC of -2.83 (95% CI: -3.21 to -2.44; p <0.000001), metropolitan areas had a higher rate of decline with an AAPC of -4.00 (95% CI: -4.31 to -3.69; p <0.000001) from 1999 to 2020. Older adults aged 65 to 85+ exhibited the most significant decrease, with an AAPC of -4.28 (95% CI: -4.81 to -3.75; p <0.000001) among all the age groups.

Conclusion: Mortality related to CAD and cardiac arrest in the United States has tremendously declined, with the most notable decrease among women, individuals aged 65 to 85+, Hispanics, those living in the Northeast region, and the non-metropolitan areas. To further reduce the mortality burden, especially among high-risk groups, it’s necessary to outline effective public health interventions.