Demographic trends in heart failure related mortality over past 2 decades

1. In this retrospective cohort analysis, heart failure (HF) related mortality has increased in young adults between 1999 and 2019.

2. There exists significant demographic trends in HF-related mortality in young adults; in particular, men were found to have a significantly higher mortality rate than women, and Black adults were found to have a significantly higher mortality rate than White and Hispanic adults.

Evidence Rating Level: 2 (Good)

Heart failure is mostly diagnosed in older adults, but there has been an increase in the proportion of young adults diagnosed with HF in recent years. This may be related to the rising burden of cardiometabolic risk factors beginning at a younger age. There exists limited data surrounding HF-related mortality in younger adults, and it is important to characterize this issue to guide future health policy measures. This study aims to investigate demographic and regional trends of HF-related mortality in young adults. Data was extracted from the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) from January 1999 to December 2019, and young adults, defined as being aged from 15 to 44, with HF as a contributing or underlying cause of death were included in the study. Crude mortality rates were determined by dividing number of HF-related deaths by the US population of that year, and age-adjusted mortality rates (AAMR) were calculated by standardizing the HF-related deaths to the 2000 US population. In total, 61729 HF-related deaths occurred in young adults in the United States. With respect to individual groups, AAMR was significantly higher in men compared to women (P<.05), and threefold higher in Black adults compared to Hispanic and White adults (P<.05). Overall, the AAMR for HF in young adults increased throughout the study duration, for both men and women, and in all race and ethnicity groups as well. This increase was Black adults had the highest increase in AAMR, followed by Hispanic and White adults. With respect to geographic trends, states in the top 10^th percentile of HF-related mortality had a significantly higher mortality burden than those in the bottom 10^th percentile. Overall, this study reports an increase in HF-related mortality in young adults in recent years and explores the demographic and regional patterns of this increase. Black adults were reported to have an increased AAMR compared to White and Hispanic adults, and significant geographic differences were reported as well. It is imperative to characterize patterns of HF-related mortality so possible contributing factors that results in variability of healthcare can be identified, and so that health policies can be developed to address these discrepancies. In terms of limitations, the increase in electronic health record use may contribute to the increase in reported HF-related mortality in recent years. In addition, further characterization of socioeconomic status of patients as well as other possible contributing factors would be ideal to identify specific risk factors.

Click to read the study in JAMA Cardiology

Image: PD

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