Temporal and demographic disparities in cardiogenic shock mortality among patients with ischemic cardiomyopathy in the United States, 1999-2020

Background Cardiogenic shock (CS) remains a critical complication in patients with ischemic cardiomyopathy (ICM), significantly impacting morbidity and mortality despite advances in cardiovascular care. As a major contributor to cardiovascular mortality, particularly among older adults in the United States, ICM represents a significant risk factor for CS development. Purpose This study aims to analyze mortality trends related to CS in patients with ICM to identify at-risk populations and inform targeted healthcare strategies, with particular focus on highlighting disparities in mortality outcomes. Methods We analyzed death certificates from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC-WONDER) database from 1999-2020 for adults (>55 years). Cases were identified with ICM (ICD-10 code: I25.5) as the underlying cause of death and CS (ICD-10 code: R57.0) as a multiple cause of death. Age-adjusted mortality rates (AAMR) per 1000,000 population were calculated and stratified by gender, race, census region, and year. Joinpoint regression analysis was performed to estimate average annual percent changes (AAPC) with corresponding 95% confidence intervals (CI). Results A total of 9,433 deaths from CS with ICM occurred between 1999 and 2020. Mortality rates initially declined significantly from 1999 to 2009 (-3.21% per year, p=0.0029), followed by a sharp increase from 2009 to 2017 (+10.19% per year, p<0.0001), then stabilized from 2017 onward (+1.19% per year, p=0.75). The AAPC of +2.34% (p=0.0067) indicated a net increase in mortality overall. Men exhibited higher AAMR than women (6.71 vs. 4.98). By age, adults ≥85 years had the highest AAMR (12.45%). Most deaths (8,516 cases, AAMR 6.42) occurred in inpatient medical facilities, followed by home (253 cases, AAMR 0.21), nursing homes/long-term care facilities (209 cases, AAMR 0.19), emergency rooms (222 cases, AAMR 0.17), and outpatient settings (143 cases, AAMR 0.12). Geographically, the Northeast region initially had the highest mortality rates but showed a marked decline after 2009, while the South had lower initial rates but experienced a steady increase throughout the study period, particularly after 2009. Regionally, the District of Columbia had the highest AAMR (10.53) while Oregon had the lowest (3.59). Rural regions showed higher mortality rates than urban areas, with rural areas experiencing a delayed but steady increase after 2010. Conclusion CS in patients with ICM demonstrated significant trends and disparities from 1999-2020, with an overall net increase despite initial decline. Notable disparities exist across gender, age, and geography, with higher mortality rates in men, older adults, and rural populations. The regional variations suggest uneven healthcare access, highlighting the need for targeted interventions to improve outcomes in high-risk populations.Figure 1.Age-Adusted Mortality Rates Figure 2.