Abstract Body: Background: While Ischemic Cardiomyopathy (ICM) remains a significant cause of heart failure and morbidity, longitudinal trends in sex-specific mortality are evolving alongside changes in guideline-directed medical therapy (GDMT) and public health stressors. We sought to characterize contemporary shifts in ICM-related mortality between males and females in the United States over a recent seven-year period.

Methods: We conducted a retrospective analysis using the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) database. Deaths were identified using the ICD-10 code for Ischaemic Cardiomyopathy (I25.5) as the underlying cause. Age-adjusted death rates (AADR) per 100,000 person-years were calculated and stratified by biological sex from 2018 through 2024.

Results: From 2018 to 2024, a total of 76,450 deaths were primarily attributed to ICM (N = 52,009 males; N = 24,441 females). The overall AADR demonstrated a gradual decline over the study period. For males, the AADR decreased from 4.9 per 100,000 in 2018 to 3.5 per 100,000 in 2024. However, in the same period, the female AADR decreased from 1.7 to 1.2 per 100,000. Although both cohorts experienced a relative reduction in AADR of approximately 29% over the seven years, the absolute mortality rate in males remained consistently ~2.9-fold higher than in females through 2024.

Conclusion: Between 2018 and 2024, mortality rates for ICM improved significantly in both sexes. However, a stark and persistent disparity in absolute mortality remains between males and females. These findings suggest that while national treatment strategies are effectively reducing the burden of disease across both groups, the underlying factors contributing to higher absolute rates in males and the distinct clinical course of the disease in females warrant continued investigation in the contemporary GDMT era.