National trends in sudden cardiac death among patients with hematologic malignancies in the United States: CDC analysis, 1999–2023.

Abstract

e18622 Background: Sudden cardiac death (SCD) is a significant cause of mortality and this risk could be more pronounced in patients with hematological malignancies because of the effects of cardiotoxic therapies, systemic inflammation and comorbidity in cardiovascular disease. As survival from hematologic cancers has improved, understanding long-term population trends in SCD-related mortality has become increasingly relevant to survivorship care and cardio-oncology risk stratification. However, national long-term trends in SCD-associated mortality within this population remain poorly characterized. Methods: Death certificate data from the CDC WONDER database for adults aged ≥65 years from 1999 to 2023 were analyzed. Sudden cardiac death was defined using multiple cause of death ICD-10 codes I46.0, I46.1, and I46.9, while hematologic malignancies were identified as the underlying cause of death using ICD-10 codes C81–C96. Age-adjusted and age-specific mortality rates per 100,000 persons were calculated. Temporal trends were assessed using annual percent change (APC) and average annual percent change (AAPC) via Joinpoint regression. Results: From 1999 to 2023, 95,677 adults aged ≥65 years died from sudden cardiac death associated with hematological malignancies in the United States. The overall age-adjusted mortality rate (AAMR) was 11.69 in 1999, declining to 6.76 in 2023, with a significant downward trend over the study period (AAPC: −1.98%; 95% CI [−2.13 to −1.83]; p < 0.000001), and no joinpoints identified. AAMRs were consistently higher in men (12.00) than women (7.08), although both sexes experienced significant declines over time (males AAPC: −1.80%; 95% CI [−1.99 to −1.61]; p < 0.000001; females AAPC: −2.42%; 95% CI [−2.57 to −2.28]; p < 0.000001). Across race and ethnicity, Hispanic or Latino individuals exhibited the highest AAMR (11.86), followed by non-Hispanic Black (10.56), non-Hispanic Asian or Pacific Islander (9.50), and non-Hispanic White populations (8.97). All racial and ethnic groups demonstrated significant long-term declines, with the steepest reductions observed among Asian or Pacific Islander (AAPC: −2.71%; 95% CI [−3.17 to −2.25]; p < 0.000001). Regionally, the Northeast had the highest mortality burden (AAMR: 15.11) and the Midwest had the lowest AAMR (4.19). Conclusions: Targeted interventions are needed to address sudden cardiac death–related mortality among patients with hematologic malignancies in the United States. Efforts should focus on sustained surveillance, improved cardiovascular risk stratification, and survivorship-oriented cardio-oncology care, alongside targeted screening and prevention strategies.