Temporal trends and disparities in mortality associated with heart failure and underlying ischemic heart disease in the US population

Heart Failure (HF) remains a significant public health concern, frequently associated with ischemic heart disease (IHD) as a major underlying condition in mortality statistics. Using national death certificate data, we evaluated population-level mortality trends and estimates among individuals in whom IHD was recorded as the underlying cause and HF as a contributing factor to characterize long-term epidemiological shifts and identify high-risk subgroups. We used the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database and extracted Multiple Cause-of-Death records for adults aged 25 and older from 1999 to 2023. We isolated cases where IHD was the underlying cause and HF was a contributing factor. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 persons of the underlying United States population and standardized to the 2000 United States standard population. Temporal trends were evaluated using Join point regression to compute the annual percent change annual percent change across demographic and geographic strata. A total of 2050,021 deaths were identified during the study period. Overall AAMRs declined significantly from 1999 to 2012 (annual percent change −4.89), but this reduction plateaued to a milder decline through 2023. Males exhibited consistently higher mortality than females. While older adults experienced continuous mortality declines, rates among middle-aged and young adults have increased significantly over the past decade. Geographically, the Midwest region and non-metropolitan areas maintained the highest AAMRs. Despite substantial reductions in HF-associated mortality with IHD as the underlying cause between 1999 and 2012, this progress has recently stabilized. Persistent disparities across sex, age, race, and location emphasize the need for targeted preventive strategies.