A cardio-oncologic burden: Leukemia-associated arrhythmia mortality in the United States (1999-2023).

e18634 Background: Leukemia remains a major contributor to cancer-related mortality in the United States. Cardiac arrhythmias are common in patients with leukemia due to pre-existing cardiovascular disease, myocardial infiltration, chronic inflammation, and treatment-related cardiotoxicity. However, national long-term mortality trends involving both conditions are poorly characterized. We examined temporal patterns and demographic and geographic disparities in leukemia-associated arrhythmia mortality among middle-aged and older adults. Methods: We analyzed U.S. mortality data from the CDC WONDER Multiple Cause of Death database (1999–2023). Deaths among adults aged ≥45 years with leukemia (ICD-10 C91–C95) and cardiac arrhythmias (ICD-10 I47–I49) listed as underlying or contributing causes were included. Analyses were stratified by age, sex, race, census region, state, urbanization, and place of death. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population. Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC); P < 0.05 was considered significant. Results: From 1999–2023, 32,350 deaths occurred among adults aged ≥45 years with leukemia and arrhythmias. Mortality increased gradually from 1999–2018 (APC 2.79%), followed by a marked rise from 2018–2021, with AAMRs increasing from 1.18 to 1.74 (APC 15.9%, P = 0.005), and a subsequent nonsignificant decline after 2021 (APC −2.0%, P = 0.64). Similar surges were observed in males (APC 12.78%) and females (APC 14.86%). AAMRs doubled among adults aged 45–64 years (AAPC 4.35%, P = 0.002) and ≥65 years (AAPC 3.97%, P < 0.001). Mortality increased significantly among White individuals (AAPC 3.90%, P < 0.001) but remained stable among Black individuals (AAPC 2.83%, P = 0.076). All census regions showed rising trends, greatest in the South (AAPC 4.72%) and West (4.58%). Rates increased in both metropolitan and non-metropolitan areas. Most deaths occurred in inpatient facilities (43%), followed by homes (27%). Conclusions: Leukemia-associated arrhythmia mortality has increased substantially over the past 25 years, with a pronounced acceleration between 2018 and 2021. Persistent demographic and regional disparities underscore the need for enhanced cardio-oncology integration, arrhythmia surveillance, and targeted cardiovascular risk management in patients with leukemia.