Forecasting Heart Failure Mortality in the United States Through 2050: A CDC WONDER Analysis

Background Heart failure remains a major and growing cause of mortality in the United States, yet contemporary long-term trends and future projections across demographic and geographic subgroups are not fully characterized. This study examined temporal patterns, disparities, and forecasts of heart failure mortality in U.S. adults through 2050. Methods We conducted an ecological time-series analysis using CDC WONDER multiple cause-of-death data from 1999 to 2025. Heart failure–related deaths were identified using ICD-10 codes I50.0, I50.1, I50.9, I11.0, I13.0, and I13.2 in the multiple-cause-of-death fields. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 U.S. standard population. Temporal trends were assessed using joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Forecasts through 2050 were generated using an ensemble of Holt linear-trend and damped-trend exponential smoothing models. Analyses were stratified by age, sex, race and ethnicity, urbanization, census region, state, and place of death. Results Overall AAMRs were 167.4 in 1999 and 172.1 in 2025 (AAPC: −0.02; 95% CI: −0.55 to 0.52, P = .94), reflecting a significant decline from 1999 to 2012, an increase through 2021, and stabilization thereafter, with no significant net change over the observed period. AAMRs are projected to rise to 227.2 by 2050. Adults aged 65–85 + years had the highest mortality burden and are projected to show the greatest future increase, whereas adults aged 25–44 years are projected to decline. Males had higher mortality than females and are expected to maintain a greater burden through 2050. Black or African American populations had the highest observed and projected mortality, while Asian or Pacific Islander populations had the lowest projected rates. Non-metropolitan areas consistently showed higher mortality than metropolitan areas, and the Midwest and South had the greatest regional burden. Deaths occurred most often in inpatient facilities, followed by home and nursing home or long-term care settings. Conclusions Heart failure mortality in the United States is projected to increase through 2050 if recent trends continue, with persistent disparities across age, sex, race, and geography. Targeted prevention, equitable access to care, and region-specific public health strategies are needed to reduce the future burden of heart failure mortality.