Mortality Trend in Patients With Heart Failure and Psychoactive Substance Abuse in the United States—Pre‐ and Post‐COVID‐19 Pandemic Perspective (1999−2023)

Background This study evaluates national trends in heart failure (HF) and psychoactive substance abuse‐related mortality among adults aged 25 years and older in the United States (US) from 1999 to 2023, stratified by sex, age, race/ethnicity, geographic regions, and the COVID‐19 pandemic period. Methods Data from 1999 to 2023 were extracted from the CDC WONDER database. Age‐adjusted mortality rates (AAMR) and annual percentage changes (APC) were calculated using Joinpoint regression. ICD‐10 codes I50, I50.1, I50.9 (Heart Failure), and F10‐19 (Psychoactive Substance Use) were used to identify the conditions. Results A total of 771 739 deaths were recorded from 1999 to 2023 among individuals aged 25 and older. Most deaths occurred in medical facilities (39.24%), followed by decedents' homes (34.14%), long‐term care facilities (16.30%), hospice (6.65%), and other settings (3.67%). The AAMR increased markedly from 1.68 in 1999 to 20.7 in 2023 (AAPC of 12.09, 95% confidence interval [CI]: 10.97−14.26). A substantial increase was observed from 1999 to 2005 (APC: 38.5%, 95% CI: 29.1–55.8), followed by a slower increase until 2020 (APC: 5.68%, 95% CI: 5.02–14.8). Men showed consistently higher AAMRs than females (18.8 vs. 8.65). By age group, mortality was highest among individuals aged 65 years and older. Conclusion Using CDC WONDER data (1999–2023), we found a sharp rise in HF mortality linked to psychoactive substance abuse, from 1.68 to 20.7 per 100 000. Mortality burden was highest among males, older adults, non‐Hispanic White individuals, and rural populations, highlighting widening demographic and geographic disparities.