Temporal trends in heart failure and stroke-related mortality in the United States, 1999–2023

BACKGROUND: Heart failure (HF) and stroke remain among the leading causes of cardiovascular mortality in the U.S. However, the intersection of these two conditions has been underexplored in national mortality data. This study investigates temporal, demographic, and geographic trends in stroke-related deaths among individuals with HF from 1999 to 2023. METHODS: Using the CDC WONDER database, we extracted multiple cause-of-death records for adults ≥25 years where both HF and stroke were listed. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the 2000 U.S. standard population. Joinpoint regression identified significant trends and calculated average annual percent changes (AAPCs). RESULTS: From 1999 to 2023, 465,695 deaths were attributed to both HF and stroke. AAMRs declined steadily from 13.46 in 1999 to a low of 7.19 in 2019 (AAPC: -3.2%; 95% CI: -3.3 to -3.0; p < 0.001) but then increased to 8.69 by 2023. Men had consistently higher AAMRs than women (2023: 9.88 vs. 7.71). NH Black individuals experienced the highest AAMRs (13.79 in 2023), slower declines, and an earlier mortality crossover compared to other groups. Adults aged 25-44 exhibited the steepest increase. Geographically, the South and rural counties bore the highest burden. CONCLUSION: Despite long-term mortality declines, recent reversals-especially post-pandemic and among younger, male, and racially minoritized populations-signal urgent gaps in equity and access.