Temporal trends and projected mortality of myocardial infarction and heart failure in the United States, 1999–2035: a CDC WONDER analysis

Background Myocardial infarction (MI) and heart failure (HF) remain major contributors to cardiovascular mortality in the United States. This study analyzed national MI- and HF-related mortality trends from 1999 to 2024 and projected rates through 2035. Methods Mortality data for adults aged ≥25 years with MI- and HF-related deaths (ICD-10 codes I21–I22 and I50) were obtained from CDC WONDER. Age-adjusted mortality rates (AAMRs), standardized to the 2000 U.S. population, were calculated. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Forecasts through 2035 were generated using Auto-ARIMA and Prophet models. Results From 1999 to 2024, 552,835 myocardial infarction (MI)- and heart failure (HF)-related deaths were recorded in the United States. The mean age-adjusted mortality rate (AAMR) across the study period was 9.73 per 100,000 population. The national AAMR declined from 15.32 in 1999 to 7.55 in 2024, with a significant decrease from 1999 to 2012 (APC = −5.39%, p < 0.000001) followed by relative stabilization thereafter. By 2035, the national AAMR is projected to increase modestly to 8.41 (95% CI: 7.46–9.31). Mortality rates were consistently higher in men than women (mean AAMR: 12.33 vs. 7.87 per 100,000) and in non-Hispanic Black individuals compared with non-Hispanic White and Hispanic individuals (10.59 vs. 9.92 vs. 7.70 per 100,000). Regional variation persisted, with the South demonstrating the highest mortality burden (mean AAMR: 10.52; projected 2035: 10.25) and the Northeast the lowest (mean AAMR: 8.34; projected 2035: 3.75). Mortality remained highest among adults aged ≥65 years, while increasing among adults aged 25–44 years after 2010. Rural populations consistently exhibited higher mortality than urban populations, with projected 2035 AAMRs of 13.94 and 7.73 per 100,000, respectively. Conclusions Although MI- and HF-related mortality declined substantially from 1999 to 2024, progress slowed after 2012, with persistent demographic and geographic disparities across age, race, region, and rurality. Younger adults, rural populations, and non-Hispanic Black individuals continue to experience disproportionately higher mortality burdens, underscoring the need for equitable prevention strategies and improved cardiovascular care access