Abstract 4371766: Trends of Acute Myocardial Infarction and Ventricular Arrhythmias Related Mortality in the United States from 1999–2020

Background: Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. Ventricular arrhythmias (VAs), including ventricular tachycardia and ventricular fibrillation, are often life-threatening in setting of AMI. While advances in revascularization have improved outcomes, the burden of AMI and VA-related mortality across U.S. subpopulations remains unclear. We aimed to assess trends and demographic disparities in AMI and VA-related deaths in the United States. Methods: We analyzed national mortality data from the CDC WONDER database between 1999 and 2020. Deaths attributed to AMI and VAs were identified using ICD codes. Age-adjusted mortality rates (AAMRs) per 100,000 population and 95% confidence intervals (CIs) were calculated and stratified by sex, race/ethnicity, age group, and geographic region. Results: A total of 71,036 deaths were attributed to AMI and VAs over the study period. The AAMR declined sharply from 2.41 in 1999 to 1.08 in 2007 (APC: -9.91; 95% CI: -10.7 to -9.02). From 2007 to 2020, a gradual decline in mortality was observed (1.08 to 1.01) (APC: -0.83; 95% CI: -1.47 to -0.19). Men had consistently higher AAMR than women from 1999 (4.39 vs 1.88) to 2020 (1.84 v s0.68); moreover, since 2008, no significant decline in mortality was observed for males. Whites had the highest number of deaths (n=62,157; AAMR: 1.51 [95% CI: 1.50–1.52]), followed by Blacks or African Americans (1.43 [95% CI: 1.39–1.46]), American Indians (1.10 [95% CI: 0.98–1.22]), Hispanics (1.04 [95% CI: 1.00–1.07]), and Asian or Pacific Islanders (0.89 [95% CI: 0.85–0.94]). All races had a significant decline in mortality across years; however, Hispanics had a rise in mortality from 2011-2020 (APC: 3.06; 95% CI: 0.82 to 5.36). Mortality increased markedly with age: older adults (≥65 years) had a 49-fold higher AAMR (5.38 vs 0.11) compared to younger adults. There was also a significant state-wide difference in mortality as shown in Figure 1. Conclusion: AMI and VA-related mortality in the US from 1999–2020 remained substantial, with significant disparities by age, sex, race, and region. Older adults, males, and those residing in the South experienced the highest mortality burden. Hispanic had a increase in mortality since 2011. These findings underscore the continued need for targeted prevention, early recognition of electrical complications of AMI, improved post-AMI surveillance, and equitable access to life-saving interventions like ICDs.