Trends in heart failure-related mortality among breast cancer patients in the United States from 1999 to 2024.

BACKGROUND

There is a paucity of data among women with breast cancer and heart failure (HF)-related mortality trends based on race, ethnicity, and geographic regions in the United States.

OBJECTIVE

To investigate the trends in HF-related mortality among breast cancer patients aged ≥25 years.

METHODS

This retrospective analysis utilized mortality data from the US Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database from 1999 to 2024. We analyzed temporal trends in the HF-related mortality in breast cancer patients aged ≥25 years. Crude (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 people with the associated annual percentage change (APC) and 95% confidence intervals (CIs) were calculated. Joinpoint regression was used to analyze trends across the overall sample and various demographic and geographic subgroups.

RESULTS

Between 1999 and 2024, 8398 death certificates identified HF as the primary cause and breast cancer as a contributory cause, resulting in an AAMR of 0.139 per 100,000. The overall AAMR significantly declined from 1999 to 2014 (APC: -5.443%, 95% CI: -6.436 to -4.440), followed by a significant increase from 2014 to 2024 (APC: 6.299%; 95% CI: 4.475 to 8.155). Racial disparities were noted, with NH Black patients exhibiting the highest AAMR of 0.176 (95% CI: 0.121 - 0.248). Geographical differences were also observed, with Mississippi having the highest AAMR of 0.324 (95% CI: 0.270 - 0.379) and Florida having the lowest AAMR of 0.053 (95% CI: 0.045 - 0.061). Additionally, from 1999 to 2020, nonmetropolitan areas consistently showed higher AAMRs than metropolitan areas with rates of 0.159 (95% CI: 0.151 - 0.168) and 0.119 (95% CI: 0.116 - 0.123), respectively. Among the age groups, the highest CMR was observed in patients aged ≥85 years (CMR: 4.859).

CONCLUSION

The persistent rise in HF-related mortality, especially pronounced among NH Black patients and in specific geographic locales, underscores the need for enhanced collaborative efforts across oncology, cardiology, cardio-oncology, public health, and policy domains to lessen disparities and improve the overall health outcomes of breast cancer survivors.