Abstract Body: Introduction Dilated cardiomyopathy (DCM) is increasingly identified cause of cardioembolic ischemic stroke. We aim to analyze annual mortality trends and demographic factors related to stroke in DCM patients in the U.S. & Texas from 1999 to 2020,with the goal to guide public health initiatives & enhance prevention strategies.MethodsThe data from the CDC's WONDER database from 1999 to 2020,focusing on stroke and DCM-related mortality (ICD-10 code I64.0 “Stroke” & Code I42.0 “DCM”) in adults aged ≥25 years was analyzed using joint point regression analysis, annual percent changes (APCs) in age-adjusted mortality rates (AAMRs) with 95%confidence intervals across various demographic (sex, race/ethnicity, age) subgroups were calculated. ResultsThe AAMR for stroke-associated DCM related mortality decreased in the US from an adjusted rate (AR) 99.6 in 1999 to 50.4 in 2015 (APC: -3.10%; 95% CI: -3.52% to -1.82%) after which it further reduced to 40.2 in 2018 (APC: -7.46%; 95% CI: -8.35% to -6.34%) & then it increased to 44 in 2020 (APC: 4.25%; 95% CI: 2.47% to 5.79%). In Texas, AAMR for stroke-associated DCM-related mortality decreased from AR 107.8 in 1999 to 41.6 in 2018(APC: -8.31%; 95% CI: -10.36% to -4.74%)after which it increased to 42.6 in 2020(APC: 2.35%; 95% CI: -5.11% to 6.54%). Males had higher consistently higher AAMRs than females (49.1 vs. 39.4). The AAMR in the US men decreased from 107.2 in 1999 to 43.1 in 2018(APC: -6.89%; 95% CI: -7.96% to -5.69%) and then it increased to 49.1 in 2020 (APC: 6.36%; 95% CI: 4.33% to 8.25%). The AAMR in the US women decreased from 93.3 in 1999 to 37.3 in 2018 (APC: -7.85%; 95% CI: -9.15% to -6.44%) after which it increased to 39.4 in 2020(APC: 2.33%; 95% CI: -0.51% to 4.69 %). The non-Hispanic (NH) Black or African American (AA) has the greatest AAMR (71.4), followed by the NH American Indian or Alaska Native with an AAMR (46) and the NH White population with an AAMR (42.2). The low-risk populations were the Hispanic or Latino(34.1) and the NH Asian or Pacific Islander (30.7). Oklahoma, Arkansas, Mississippi, & Alabama in the upper 90th percentile for stroke-associated DCM-related AAMRs, showed about twice the mortality rates compared to states in the lower 10th percentile.ConclusionsThe mortality rates from stroke-associated DCM have overall risen in both the United States and Texas over past two decades, specifically men and (NH) Black or AA, (NH) American Indian or Alaska Native and (NH) White, are at high risk.