What is the clinical evidence from this study?

Study design: Observational. Population: Coexisting Coronary Artery Disease (CAD) and Heart Failure (HF) (n=2930567). Intervention: Calendar year (1999-2024) vs. 1999. Primary outcome: Age-adjusted mortality rate (per 100,000).

What question did this study set out to answer?

This research aims to explore U.S. mortality trends for coexisting coronary artery disease and heart failure from 1999 to 2024 and to identify demographic and geographic disparities.

June 12, 2026Open Access

Trends and Racial‐Geographic Disparities in Coexisting Coronary Artery Disease (CAD) and Heart Failure (HF) Related Mortality Among U.S. Adults, 1999–2024

Key Result

Age-adjusted mortality for coexisting CAD and HF in U.S. adults declined significantly from 71.6 per 100,000 in 1999 to 43.7 in 2024, with persistent demographic and geographic disparities.

Key Points

This research aims to explore U.S. mortality trends for coexisting coronary artery disease and heart failure from 1999 to 2024 and to identify demographic and geographic disparities.
Analyzed CDC WONDER multiple-cause-of-death data for adults aged 25 years and older.
Calculated age-adjusted mortality rates standardized to the 2000 U.S. population.
Employed joinpoint regression to estimate annual percent changes in mortality.
From 1999 to 2024, 2,930,567 deaths involved coexisting CAD and HF, with an overall decline in age-adjusted mortality rates from 71.6 to 43.7 per 100,000.
Mortality rates were higher for men (67.5) compared to women (39.8), though the decline was steeper in women.
Significant geographic mortality variation revealed the Midwest had the highest rates (54.6), while Asian or Pacific Islanders experienced the lowest (25.0).

Study Design

Type

Observational (n=2,930,567)

Multicenter

Yes

Structured PICO

Population

2,930,567 deaths among U.S. adults ≥ 25 years involving coexisting CAD and HF from 1999 to 2024.

Outcome

Age-adjusted mortality rates (AAMR) per 100,000 populationhard clinical

While overall mortality for coexisting CAD and HF in the U.S. declined from 1999 to 2024, significant demographic and geographic disparities persist, highlighting the need for targeted prevention in high-risk populations.

Main Result

Absolute Event Rate: 43.7% vs 71.6%

Abstract

ABSTRACT Background Coronary artery disease (CAD) and heart failure (HF) frequently coexist, yet national mortality trends capturing both conditions together remain understudied. We examined U.S. mortality trends where CAD and HF coexisted from 1999 to 2024. Methods We analyzed CDC WONDER multiple‐cause‐of‐death data for adults ≥ 25 years to identify deaths with coexisting CAD and HF. Age‐adjusted mortality rates (per 100,000) were standardized to the 2000 U.S. population. Joinpoint regression estimated annual percent changes, and mortality was stratified by demographics, region, and clinical presentation. Results From 1999 to 2024, 2,930,567 deaths involved coexisting CAD and HF, with 32.82% occurring in inpatient settings. The AAMR declined significantly from 71.6 in 1999 to 43.7 in 2024. Men had higher mortality than women (67.5 vs. 39.8), although declines were steeper in women. White adults had the highest AAMR (52.6), while Asian or Pacific Islanders had the lowest (25.0). The Midwest recorded the highest mortality (54.6), and the Northeast the lowest (47.1). Mortality was higher in rural areas than in urban areas (63.6 vs. 49.5). Older adults had the greatest burden (240.9), whereas younger adults showed increasing trends after 2010. Chronic ischemic cardiomyopathy recorded higher mortality as compared to acute myocardial infarction (9.85 vs. 4.41), although the decline was greater for chronic infarctions. State‐level variation was notable, with West Virginia and Oklahoma consistently among the highest. Conclusion Mortality involving coexisting CAD and HF declined overall but showed persistent demographic and geographic disparities. Targeted prevention strategies are needed to reduce the ischemic HF burden in high‐risk populations.