Abstract WE409: Rising Cardiac Arrest–Related Mortality Among Amyloidosis Decedents in the United States, 1999–2023

Abstract

Background: Cardiac amyloidosis is an underrecognized cause of heart failure and cardiac arrest. Amyloid fibril deposition in the myocardium causes restrictive physiology and conduction abnormalities leading to cardiac arrest. Despite diagnostic and therapeutic advances, national mortality trends remain unclear. This study evaluated temporal and demographic patterns in cardiac arrest–related mortality among amyloidosis decedents in the United States. Methods: Data from the CDC WONDER Multiple Cause of Death database (1999–2023) were analyzed to identify adults (≥25 years) with both cardiac arrest (I46.x) and amyloidosis (E85.x) listed on death certificates. Age-adjusted mortality rates (AAMRs) per 100 000 population (2000 U.S. standard) and annual percent changes (APCs) were calculated using Joinpoint regression across sex, race, region, urbanization, and age groups. Results: From 1999 to 2023, 6,312 deaths involved both cardiac arrest and amyloidosis. The AAMR remained stable from 1999–2014 (≈0.09 to 0.10; APC = +0.2 %, p = 0.79) but increased markedly to 0.17 by 2023 (APC = +6.7%, p < 0.001). Males had higher mortality than females (AAMR 0.13 vs 0.08) and demonstrated a greater post-2011 rise (APC +6.9%, p < 0.001). By race, Black decedents showed a steady increase (APC +4.2 %, p < 0.001), while White decedents remained stable until 2014, followed by a significant acceleration (APC +7.7 %, p < 0.001). Mortality rose most sharply among adults aged ≥75 years (APC +7.0 %, p < 0.001). Geographically, the South and Northeast exhibited the highest rates of increase, and by urbanization, mortality climbed most in large-fringe metropolitan areas.The rising trend persisted through 2023, indicating a sustained national increase beyond the pandemic period. Conclusions: Cardiac arrest–related mortality among amyloidosis decedents has risen markedly since 2014. The trend parallels improved disease recognition via bone scintigraphy, cardiac MRI and therapies such as tafamidis. Persistent disparities were evident, with men, older adults, and Black individuals experiencing disproportionate increases. These patterns likely reflect a combination of hereditary factors, including the V122I transthyretin variant, delayed diagnosis, and unequal access to specialized care.Broader awareness, early screening in high-risk groups, and equitable integration of amyloidosis management into cardiac-arrest prevention efforts are essential to address this evolving cardiovascular disparity.