Demographic and regional trends of heart failure and cachexia-related mortality among older adults in the United States, from 1999 to 2020

Cachexia is a debilitating yet under-recognized condition, particularly among the elderly population. It has been shown that patients with heart failure (HF) often have cachexia, leading to worsening mortality rates. There is limited research on mortality trends and demographic disparities in terms of cachexia. CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging ONline Data for Epidemiologic Research) database was used, where HF and cachexia were listed as either contributory or underlying causes of death in adults >65 years from 1999-2020. Age-adjusted mortality rates (AAMRs) and annual percent changes (APC) were calculated and stratified by year, sex, race/ethnicity, and region. No change in mortality was seen due to HF + cachexia from 2004-2020 (APC -2.1%; 95% CI, -3.2 to 0.6). Almost half of the deaths (47%) occurred within nursing homes. Notably, White adults had a higher mortality than Black/ African American adults (23.8; 95% CI, 23.4 to 24.1 vs 18.4; 95% CI, 17.4 to 19.4). Mortality rates were also higher in rural areas than urban areas (27.9; 95% CI, 27.1 to 28.7 vs 22.1; 95% CI, 21.8 to 22.4). States in the top 90th percentile, including Idaho, Utah, Vermont, South Carolina, Alaska and New Hampshire, had 5-fold higher mortality than states in the lower 10th percentile. No change in mortality was seen due to HF and cachexia-related mortality in the last decade, with substantial racial and regional disparities. Targeted interventions are needed to curb these mortality trends.