Trends in mortality due to heart failure and malignant neoplasms among adult patients in the United States: A 25-year nationwide retrospective analysis with 12-year future projections.

Abstract

e24002 Background: Malignant neoplasms and heart failure (HF) are major contributors to morbidity and mortality in older adults. Although the interplay between cancer and HF has gained increasing attention, national patterns of HF-related mortality among individuals with malignant neoplasms remain insufficiently described. Understanding these trends is crucial, as HF represents a potentially preventable cause of death with important implications for prognosis, clinical management, and healthcare system planning. This study examines national trends in HF and malignant neoplasms-related mortality among patients across demographic and geographic subgroups in the United States from 1999 to 2023. Methods: A retrospective analysis of CDC WONDER mortality data from 1999 to 2023 was performed. Deaths related to malignant neoplasms (ICD-10 C00–C97) and HF (ICD-10 I50) were identified, and age-adjusted mortality rates (AAMRs) were calculated. Joinpoint regression was used to evaluate annual percent change (APC) in mortality trends, with stratification by age, sex, race/ethnicity, and geographic region, including census divisions and state-level patterns. 12 Year (2024-2035) future mortality trends were projected using an autoregressive integrated moving average (ARIMA) time-series model. Results: A total of 684,474 deaths occurred between 1999 and 2023. The majority occurred in inpatient medical facilities (33.15%) or at home (32.08%). National AAMRs declined from 1999 to 2012 but reversed thereafter, rising from 10.20 in 2012 to 14.60 in 2023. Forecasts predict a continued increase to 15.19 by 2035. Significant early declines were observed across demographic groups, followed by subsequent increases beginning in the mid-2010s. Males consistently exhibited higher AAMRs than females, and older adults (65–85+) experienced the highest mortality burden. Racial disparities revealed the highest AAMRs among Non-Hispanic Black and Non-Hispanic White populations. Geographic variation was substantial: the Midwest had the highest regional AAMR, while the Northeast had the lowest. State analyses revealed the highest AAMR in Mississippi (21.15) and the lowest in Arizona (6.95). States such as Mississippi, Nebraska, Oregon, North Dakota, and Oklahoma demonstrated the greatest mortality burdens. Conclusions: U.S. mortality related to HF and malignant neoplasms shows a concerning reversal of prior improvements, with rising AAMRs since 2012 and persistent sociodemographic and geographic disparities. Forecasted increases through 2035 highlight an urgent need for targeted public health strategies, equitable healthcare access, and intensified chronic disease prevention and management efforts. These findings highlight the importance of monitoring at-risk populations and addressing systemic factors.