Abstract Body: Introduction:
Heart disease remains the leading cause of mortality worldwide. We examined global heart disease mortality trends over the past three decades to assess progress made and to identify areas of need, including regional disparities.

Methods:
We used data from the Institute for Health Metrics and Evaluation (IHME) Global Burden of Disease program. We analyzed the age-adjusted mortality from 1990 to 2022 for overall heart disease, ischemic and non-ischemic heart disease, and by non-ischemic subtypes including atrial fibrillation and flutter, cardiomyopathy, endocarditis, hypertensive heart disease, myocarditis, non-rheumatic valvular heart disease, pulmonary arterial hypertension, rheumatic heart disease, and other cardiovascular and circulatory diseases. For 2022, we compared age-adjusted mortality of ischemic and non-ischemic subtypes by IHME socioeconomic and geographic regions.

Results:
From 1990 to 2022, overall global heart disease age-adjusted mortality decreased 35%, from 358 per 100,000 to 233 per 100,000. Ischemic heart disease mortality decreased 33%, from 160 per 100,000 to 108 per 100,000 (Figure 1). Mortality for all non-ischemic subtypes decreased except for atrial fibrillation and flutter, which increased 9.5% (Figure 2). Notably, cardiomyopathy mortality decreased 71% and rheumatic heart disease mortality decreased 57%.

In 2022 there were notable disparities; Mortality for cardiomyopathy in Central & Eastern Europe / Central Asia was three times greater than the global mortality rate (Figure 3). Mortality for hypertensive heart disease in Sub-Saharan Africa and the Middle East & North Africa was over twice the global mortality rate. Mortality for rheumatic heart disease in South Asia was more than three times the global mortality rate.

Interpretation:
Significant progress has been made in heart disease mortality over the last three decades. However, disparities exist by geographic and socioeconomic region, particularly for cardiomyopathy, hypertensive heart disease, and rheumatic heart disease. Public health strategies addressing resource allocation and equitable access to prevention and treatment are needed.

Conclusion:
There have been substantial declines in global heart disease mortality. However, stark regional disparities underscore the urgent need for targeted prevention and treatment efforts.