Longitudinal trends in heart failure mortality linked to coronary artery disease among adults 65 years and older

Background: Heart failure (HF) in patients with coronary artery disease (CAD) is a leading cause of mortality among older adults in the United States. This study examines trends in HF with CAD-related mortality among adults aged 65 and older. Methods: A retrospective analysis was performed using the CDC WONDER database death certificates from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region. Results: HF associated with CAD led to 1597,451 deaths among adults > 65, primarily occurring in medical facilities (37.1 %). The AAMR for HF with CAD decreased from 241.7 in 1999 to 156.2 in 2020 (AAPC:2.23, p < 0.001), which was significant from 1999 to 2014. Men had higher AAMRs than women (227.4 vs. 137.1), with women's rates declining more significantly (AAPC:3.23, p < 0.001). White adults had the highest AAMRs (183.0), while Asians/Pacific Islanders (81.6) recorded the lowest. Geographically, AAMRs varied, from 92.1 in Hawaii to 257.3 in West Virginia, with the Midwest showing the highest mortality (191.0). Nonmetropolitan areas exhibited higher AAMRs than metropolitan areas (202.6 vs. 166.1) Conclusions: Our study reveals striking disparities in HF-related mortality among adults aged 65 years and older in the United States. While AAMRs decreased overall from 1999 to 2014, they have reached an inflection point since 2019, indicating rising mortality rates. Persistent inequalities underscore the critical need for targeted public health interventions to address these issues.