Trends in Mortality Associated with Acute Ischemic Stroke and Heart Failure in the United States, 1999-2020
Prince Pekyi-Boateng1, Sylvia Tawiah-Eshun1, Rutvi Amin2, Courage Dogbe3, Kamleshun Ramphul3, Jana Wold4
1University Of Utah Health, 2Oakland Park Regional Medical Center, 3Independent Researcher, 4University of Utah Medical Center
Objective:
Describe mortality trends from 1999 to 2020 among patients with Heart Failure (HF) and Acute Ischemic Stroke(AIS)
Background:
AIS and HF are major causes of U.S. mortality, often co-occurring due to shared risk factors. Despite treatment advances, temporal trends in combined AIS-HF mortality are understudied. This analysis examines national mortality patterns to guide neurologic and cardiovascular interventions.
Design/Methods:
This was a retrospective analysis of the CDC WONDER Multiple Cause of Death database for deaths among adults aged ≥25 years where HF was the underlying or contributing cause and AIS was listed among multiple causes (ICD-10: I50, I63). Data from 1999-2020 were stratified by age, sex, race/ethnicity, and state. Age-adjusted mortality rates (AAMRs) were standardized to the 2000 U.S. population. Temporal trends were assessed, calculating annual percentage change (APC) and average annual percent change (AAPC) with 95% confidence intervals (p<0.05)
Results:
AIS-HF AAMR declined from 1999-2004 (APC: -10.54; 95% CI: -14.08 to -6.83; p<0.05) and 2004-2007 (APC: -20.80; 95% CI: -43.61 to 11.23; p=0.15), slowing from 2007-2014 (95% CI: -5.2 to -1.7; p=0.30). Rates rose sharply from 2014-2017 (APC: 36.87; 95% CI: 8.7 to 72.32; p<0.05) and 2017-2020 (APC: 12.53; 95% CI: 4.8 to 20.80; p<0.05). The overall AAPC (1999-2020) was nonsignificant (-0.39; 95% CI: -5.47 to 4.94; p=0.88). By sex, males and females showed declines until ~2008, reversing to significant increases from 2014-2020. Racial/ethnic trends mirrored this pattern, with non-Hispanic Blacks and Hispanics/Latinos showing sharper recent increases, though overall AAPCs remained nonsignificant.
Conclusions:
Early declines in AIS-HF mortality reversed after ~2014, possibly due to aging populations or care disparities. Targeted interventions, especially for minority groups, are critical to address this rising burden. Geographic analyses could identify key areas for intervention.
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