Abstract 4369805: Trends and Disparities in Acute Myocardial Infarction Mortality Among U.S. Adults With Heart Failure, 1999–2024

Background: Acute myocardial infarction (AMI) frequently complicates heart failure, yet national mortality trends in this population remain incompletely characterized. Understanding temporal patterns and disparities can guide targeted prevention strategies. Hypothesis: We hypothesized that AMI-related mortality among U.S. adults with heart failure declined from 1999 to 2012, rose during 2018–2021, and that significant disparities exist by sex, race/ethnicity, geography, and urbanization. Methods: We analyzed CDC WONDER cause-of-death data (1999–2024) for U.S. decedents aged ≥25 years with heart failure (ICD-10 I50x) and AMI (ICD-10 I21x). We calculated the total number of deaths, the proportions by place, and the annual age-adjusted mortality rates (AAMRs) per 100,000 population. Joinpoint regression estimated average annual percent change (AAPC) in AAMR. Analyses were stratified by sex, race/ethnicity, Census region, and urban/rural status. Results: From 1999 to 2024, there were 562,454 deaths related to AMI among adults suffering from heart failure. The locations of death were as follows: 57.9% occurred in medical facilities, while 21.4% occurred at home. The overall AAMR declined from 15.3 in 1999 to 8.1 in 2024, noted as an AAPC of –2.71 (p < 0.001). Significant segmented declines were observed from 1999 to 2012, followed by a period of stability from 2012 to 2018, an increase from 2018 to 2021, and a subsequent decline from 2021 to 2024 (all p < 0.05). Men exhibited a higher AAMR compared to women, with rates of 12.5 and 8.0, respectively, reflecting the overall trend. By racial demographics, the AAMRs were highest among Non-Hispanic Black individuals (10.9), followed by Non-Hispanic White individuals (10.1). Notably, Non-Hispanic Black individuals demonstrated the largest increase from 2018 to 2021 (p < 0.05). The Southern region reported the highest mean AAMR at 10.7, in contrast to the Northeast, which had a mean rate of 8.4. In 2020, the AAMR in rural areas (13.5) surpassed that of urban areas (7.4). Additionally, state-specific AAMRs ranged from 23.4 in Arkansas to 5.2 in Nevada. Conclusions: AMI-related mortality in U.S. adults with heart failure sharply declined until 2012, plateaued, surged during 2018–2021, then declined again. Disparities by sex, race/ethnicity, region, and rurality underscore the need for targeted interventions for high-risk groups, especially NH Black adults and residents in Southern and rural areas.