Trends in heart failure mortality among patients with rheumatoid arthritis in the United States (1999–2020): A nationwide cross-sectional analysis of the CDC WONDER database

Rheumatoid Arthritis (RA) is a known risk factor for heart failure (HF) due to its chronic autoimmune-mediated inflammation. However, data on trends of Rheumatoid arthritis associated HF mortality in the United States (U.S.) remain limited. This study comprehensively explores the trends in rheumatoid arthritis associated mortality attributable to HF patients in the United States. A retrospective analysis was performed using data from the Centers for Disease Control and Prevention Wide-Ranged Online Data for Epidemiologic Research database. We obtained age-adjusted mortality rates (AAMR) per 100,000 population and used Joinpoint regression to calculate the annual percentage change. The results were analyzed by year, sex, race, and geographic region to identify patterns in mortality from RA-associated HF. Between 1999 and 2020, 28,750 cases of cardiac failure in RA patients aged 55 and older were documented. In 1999, the AAMR was 2.5; by 2020, it was 1.9 (annual percentage change: −4.05 [95% CI; −6.30 to −3.13]). Sex differences did not go away, either, with women continuously having a higher AAMR (2.3) than men (1.2). The highest AAMR was 2.0 for non-Hispanic White, 1.5 for NH Black or African American, and 1.3 for Hispanic or Latino. Geographically, the Northeast had the lowest AAMR (1.4), while the Midwestern region had the highest (2.3). Nonmetropolitan areas had a greater AAMR (2.6) than metropolitan areas (1.7). Interestingly, Vermont, Oregon, Minnesota, Montana, South Dakota, and North Dakota had the highest AAMRs. Between 1999 and 2020, RA-associated HF mortality declined overall but rose again after 2018, particularly among women, non-Hispanic Whites, and residents of rural Midwestern states. Persistent disparities by sex, race, and geography highlight the need for targeted cardiovascular and rheumatologic care strategies.