Work

Pandemic-era deviation and subsequent recovery in mortality involving heart failure and acute myocardial infarction in the United States, 1999–2024

Year: 2026

Type: article

Abstract: Heart failure (HF) and acute myocardial infarction (AMI) remain major contributors to cardiovascular mortality in the United States, but contemporary national trends in mortality involving both conditions, including deviations during the COVID-19 pandemic era, are incompletely characterized. We conducted a retrospective, population-based serial cross-sectional analysis of deaths among U.S. adults aged ≥ 25 years from 1999 to 2024 using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Multiple Cause of Death database. Deaths were included when both HF and AMI were listed on the same death certificate. Long-term age-adjusted mortality rate (AAMR) trends were assessed using Joinpoint regression. Expected AAMRs for 2020–2024 were projected from 2015 to 2019 pre-pandemic trends, and interrupted time-series regression was performed as a sensitivity analysis. Between 1999 and 2024, 552,491 deaths involving both HF and AMI were identified. The AAMR declined from 15.32 to 7.55 per 100,000 population, with an average annual percent change of − 2.84% (95% CI, − 3.37% to − 2.31%). Mortality declined through 2018, increased during 2018–2021, and declined again during 2021–2024. Observed mortality exceeded the projected expected range during 2020–2022, with the largest deviation in 2021, before returning toward expected levels by 2023–2024. Mortality involving both HF and AMI declined substantially over the study period but showed a temporary pandemic-era deviation from the pre-pandemic trajectory. Mortality burden remained higher among men, non-Hispanic Black individuals, residents of the South, nonmetropolitan populations, and older adults, highlighting persistent demographic and geographic heterogeneity. Not applicable. This study was a retrospective analysis of publicly available aggregate mortality data and did not involve a clinical trial.

Source: BMC Cardiovascular Disorders

DOI: 10.1186/s12872-026-06830-5