Trends and Racial-Geographic Disparities in Coexisting Coronary Artery Disease (CAD) and Heart Failure (HF) Related Mortality Among U.S. Adults, 1999-2024.

BACKGROUND

Coronary artery disease (CAD) and heart failure (HF) frequently coexist, yet national mortality trends capturing both conditions together remain understudied. We examined U.S. mortality trends where CAD and HF coexisted from 1999 to 2024.

METHODS

We analyzed CDC WONDER multiple-cause-of-death data for adults ≥ 25 years to identify deaths with coexisting CAD and HF. Age-adjusted mortality rates (per 100,000) were standardized to the 2000 U.S. population. Joinpoint regression estimated annual percent changes, and mortality was stratified by demographics, region, and clinical presentation.

RESULTS

From 1999 to 2024, 2,930,567 deaths involved coexisting CAD and HF, with 32.82% occurring in inpatient settings. The AAMR declined significantly from 71.6 in 1999 to 43.7 in 2024. Men had higher mortality than women (67.5 vs. 39.8), although declines were steeper in women. White adults had the highest AAMR (52.6), while Asian or Pacific Islanders had the lowest (25.0). The Midwest recorded the highest mortality (54.6), and the Northeast the lowest (47.1). Mortality was higher in rural areas than in urban areas (63.6 vs. 49.5). Older adults had the greatest burden (240.9), whereas younger adults showed increasing trends after 2010. Chronic ischemic cardiomyopathy recorded higher mortality as compared to acute myocardial infarction (9.85 vs. 4.41), although the decline was greater for chronic infarctions. State-level variation was notable, with West Virginia and Oklahoma consistently among the highest.

CONCLUSION

Mortality involving coexisting CAD and HF declined overall but showed persistent demographic and geographic disparities. Targeted prevention strategies are needed to reduce the ischemic HF burden in high-risk populations.