Mortality Trend in Patients With Heart Failure and Psychoactive Substance Abuse in the United States—Pre‐ and Post‐COVID‐19 Pandemic Perspective (1999−2023)

BACKGROUND: This study evaluates national trends in heart failure (HF) and psychoactive substance abuse-related mortality among adults aged 25 years and older in the United States (US) from 1999 to 2023, stratified by sex, age, race/ethnicity, geographic regions, and the COVID-19 pandemic period. METHODS: Data from 1999 to 2023 were extracted from the CDC WONDER database. Age-adjusted mortality rates (AAMR) and annual percentage changes (APC) were calculated using Joinpoint regression. ICD-10 codes I50, I50.1, I50.9 (Heart Failure), and F10-19 (Psychoactive Substance Use) were used to identify the conditions. RESULTS: A total of 771 739 deaths were recorded from 1999 to 2023 among individuals aged 25 and older. Most deaths occurred in medical facilities (39.24%), followed by decedents' homes (34.14%), long-term care facilities (16.30%), hospice (6.65%), and other settings (3.67%). The AAMR increased markedly from 1.68 in 1999 to 20.7 in 2023 (AAPC of 12.09, 95% confidence interval [CI]: 10.97-14.26). A substantial increase was observed from 1999 to 2005 (APC: 38.5%, 95% CI: 29.1-55.8), followed by a slower increase until 2020 (APC: 5.68%, 95% CI: 5.02-14.8). Men showed consistently higher AAMRs than females (18.8 vs. 8.65). By age group, mortality was highest among individuals aged 65 years and older. CONCLUSION: Using CDC WONDER data (1999-2023), we found a sharp rise in HF mortality linked to psychoactive substance abuse, from 1.68 to 20.7 per 100 000. Mortality burden was highest among males, older adults, non-Hispanic White individuals, and rural populations, highlighting widening demographic and geographic disparities.