Burden of heart failure–related mortality among U.S. adults with leukemia (1999-2023).

e18623 Background: Cardiovascular disease is the leading non-cancer cause of death among leukemia survivors, with heart failure (HF) accounting for 12.4% of leukemia-related mortality through cardiotoxic treatment effects and inflammatory pathways. Acute HF often develops within one year of diagnosis, compromising therapy. Post–COVID-19 disruptions in cardiac monitoring may further impact survival. We analyzed trends in HF-related mortality among U.S. adults with leukemia from 1999–2023. Methods: Mortality data for adults aged ≥45 years with leukemia and HF from 1999–2023 were obtained from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent changes (APC) were estimated using Joinpoint regression, stratified by year, sex, race/ethnicity, census region, and urbanization status. Results: Between 1999 and 2023, 47,156 deaths occurred among leukemia patients with HF. Among adults aged ≥65, AAMRs were stable until 2010 (APC 0.29%, p=0.405) and then increased significantly through 2023 (APC 3.23%, p<0.001). Adults aged 45–64 showed a consistent rise (APC 1.80%, p=0.016). Regionally, the South recorded the highest total deaths (15,381; APC 2.62% from 2010–2020), the West experienced the sharpest short-term increase (APC 5.11%, 2014–2018), and the Northeast showed the greatest overall decline (AAPC −0.13%). Non-Hispanic Whites were the only racial group with a significant overall increase (AAPC 0.76%, p=0.040). Males exhibited a slight increase (AAPC 0.64%), whereas females showed a decrease (AAPC −0.30%). Non-metropolitan areas experienced a larger decrease (AAPC −0.57%) than metropolitan areas (AAPC −0.24%). Conclusions: HF-related mortality among U.S. adults with leukemia has increased in recent years after an initial period of stability or decline. Disparities are notable among males, non-Hispanic Whites, and residents of the Southern U.S. These trends underscore the need for targeted interventions, integrated cardio-oncology care, and improved cardiovascular risk management in leukemia populations. Joinpoint results summary. S. No. Characteristics AAMR (1999-2023) AAPC (95% CI) JP No. 1. Overall 1.7–1.83 0.3(-0.7-1.2) 3 2. Male 2.3–2.66 0.6(-0.4-1.7) 2 3. Female 1.36–1.23 0.01(-0.63-0.64) 1 4. 45-64 yrs 0.12–0.22 1.9(0.7-3.2) 0 5. 65+ years 4.48–4.66 0.2(-0.7-1.1) 3 6. Census Region 3 – South 1.52–1.78 0.5(-1.2-2.3) 3 7. Census Region 4 - West 1.81–1.78 0.7(-0.05-1.5) 1 8. Non Hispanic – White 1.8–2.11 0.6(-0.4-1.8) 3 9. Non Hispanic – Black and African American 1.18–1.24 0.6(-0.5-1.7) 1