Abstract 4373500: Escalating Mortality from Amphetamine-Associated Heart Failure in the United States (2003–2022): A Nationwide Analysis of Regional and Demographic Disparities

Background: Heart failure (HF) remains a leading cause of morbidity and mortality in the U.S. Concurrently, amphetamine use disorder has emerged as an increasingly recognized contributor to cardiovascular fatalities. While the broader stimulant-overdose mortality trends have been documented, specific trends in HF mortality involving amphetamine use require elucidation to guide targeted interventions. Methods: Mortality data (2003–2022) were extracted from the CDC’s National Vital Statistics System, identifying HF-listed deaths with amphetamine-type stimulants noted as a contributing cause. Absolute counts and age-adjusted rates were computed annually. Annual Average Percent Change (AAPC) was calculated for both absolute death counts and age-standardized mortality. Trends were stratified by census region, state, 2013 urbanization categories, age group, sex, race, and Hispanic origin. Results: Between 2003 and 2022, HF deaths involving amphetamine use as a contributing cause rose substantially in the U.S., with total deaths increasing from 150 to 1,500 and an overall AAPC of +12.1%. The age-adjusted mortality rate rose from 0.05 to 0.35 per 100,000 (AAPC +11.3%). Regionally, the West had the steepest rise (AAPC +13.8%), followed by the Midwest, South, and Northeast. West Virginia showed the highest state-level increase (AAPC +14.9%), with Colorado and California also showing significant growth. Non-metropolitan areas experienced the fastest rise in age-adjusted mortality (AAPC +14.2%), while large metros had a slower increase. Adults aged 25–44 years had the highest AAPC (+13.5%), followed by those aged 45–64; older adults had a smaller increase. Males were more affected, with an AAPC of +12.8% versus +9.0% in females. Among racial groups, American Indian/Alaska Native individuals had the highest burden (0.50 per 100,000 in 2022, AAPC +14.9%), followed by Black, Hispanic, and White populations, all with AAPCs above +10%. Conclusion: Deaths in which amphetamine use disorder contributes to HF have surged significantly across all demographic and geographic sectors, with disproportionate increases in young adults, rural populations, and racial minorities. The especially steep trends in non metro regions and among American Indian/Alaska Native communities signal urgent need for tailored public health initiatives, focusing on stimulant use prevention, cardiovascular screening, and substance use rehabilitation integrated with cardiac care.