Abstract 4358377: Emerging Trends and Disparities in Heart Failure and Amyloidosis–Related Mortality Among U.S. Adults: A Nationwide Analysis from 1999 to 2023

Abstract

Background: Heart failure (HF) remains a major contributor to morbidity and mortality in the United States (U.S.). Cardiac amyloidosis, a condition marked by the deposition of misfolded proteins in myocardial tissue, can lead to progressive cardiac dysfunction, precipitate HF, and worsen overall clinical outcomes. However, national trends in HF and amyloidosis-related mortality, along with the demographic disparities remain insufficiently explored. Methods: We utilized CDC WONDER data from 1999 to 2023 to examine U.S. adults aged ≥25 years whose death certificates included both HF (ICD-10: I50) and amyloidosis (ICD-10: E85.0–E85.9) as either underlying or contributing causes of death. Age-adjusted mortality rates (AAMRs) per million population were computed and stratified by sex, age group, race/ethnicity, and urbanization status (1999 to 2020 for urbanization). Temporal trends were evaluated using annual percent changes (APCs) with corresponding 95% confidence intervals, with statistical significance set at p < 0.05. Results: A total of 13,606 deaths were identified among U.S. adults with both HF and amyloidosis recorded as underlying or contributing causes of death. Between 1999 and 2013, the AAMR remained relatively stable, increasing modestly from 1.4 to 1.7 per 1,000,000 (APC: 0.87; 95% CI: –0.40 to 1.99), followed by a marked and statistically significant rise to 5.6 in 2023 (APC: 13.55; 95% CI: 12.40 to 15.09). Throughout the study period, men consistently exhibited higher AAMRs than women (3.7 vs. 1.3). Older adults aged ≥65 years had substantially higher AAMRs (11.9) compared to middle-aged adults aged 45–64 years (1.0), while AAMRs among adults aged 25–44 years were suppressed throughout the study period. By race/ethnicity, the highest AAMRs were observed among Non-Hispanic (NH) Black individuals (3.3), followed by NH White (2.1) and Hispanic (1.8) populations. AAMRs for NH American Indian/Alaska Native and NH Asian/Pacific Islander populations were suppressed or considered unreliable. From 1999 to 2020, residents of metropolitan areas had slightly higher AAMRs (2.0) compared to those in non-metropolitan areas (1.7). Conclusions: Since 2013, HF and amyloidosis-related mortality has increased markedly in the U.S. Rates have remained consistently higher in men, older adults, Non-Hispanic Black individuals, and metropolitan residents, highlighting the need for targeted public health interventions in these high risk demographic groups.