Heart Disease Mortality Rates Accelerate for Various Disease Subtypes

Nilay Shah, MD, MPH

Findings in a serial cross-sectional analysis of cause-specific heart disease mortality rates reveal that trends in age-adjusted mortality rate (AAMR) and years of potential life lost (YPLL) have remained stagnant or increased for various heart disease subtypes since 2011.

The study also showed that declining mortality rate trends have slowed down for ischemic heart disease.

Nilay Shah, MD, MPH, and investigators used death certificate data from the US Centers for Disease Control and Prevention’s (CDC) Wide-Ranging Online Date for Epidemiological Research (WONDER) database to identify deceased patients with total heart disease as main cause of death.

The heart disease subtype classifications included ischemic heart disease, heart failure, hypertensive heart disease, valvular heart disease, arrhythmia and pulmonary heart disease, as well as other heart disease.

In addition to their analysis of the overall population (n = 12.9 million), they stratified the data by race (11.7% Black; 86.2% White), sex (49.1% women), and age (81.2% ≥65).

The investigators found that total heart disease deaths fell from 752,192 in 1999 to 595, 577 in 2011. From 2011-2018, deaths increased to 655,381.

Between 1999 and 2018, the proportion of total deaths from ischemic heart disease decreased from 73% to 55.8%.

In that same time frame, however, the proportion of heart failure increased from 7.6% to 12.8%, heart disease from 3.6% to 9.2%, valvular heart disease from 2.7% to 3.7%, arrhythmia from 2.5% to 5.6%, pulmonary heart disease from 1.8% to 2.8%, and other heart diseases from 8.7% to 10.3%.

The investigators noted mean annual percentage change in AAMR for ischemic heart disease slowed from -4.7% (95% CI, -5.1 to -4.2) annually before 2011, to -2.6% (95% CI, -3.3 to -2.0) annually after 2011. As such, they identified 2011 as an inflection point in fatal ischemic heart disease rates in the US.

These trends in AAMR for heart failure have reversed and increased from -1.7% (95% CI, -2.5 to -0.8) per year before 2011 to 3.5% (95% CI, 2.6-4.5).

The mean annual percentage change in hypertensive heart disease mortality rates have accelerated from 1.2% (95% CI, 0.7-1.7%) annually prior to 2011 to 4.8% (95% CI, 3.3-6.3).

According to the investigators, this indicates that AAMR for both heart failure and hypertensive heart disease have increased at a faster rate compared to other subtypes.

After stratifying data by race, they also found that black men saw the fastest mean annual percentage change increase in heart failure mortality (4.9%; 95% CI, 4.0-5.8).

The fastest increases in hypertensive heart disease occurred in white men (6.3%; 95% CI, 4.9-9.4).

In terms of age group, particularly noteworthy was that the proportion of deaths among middle-age decendents (45-64) increased from 13.7% to 17.3% between 1999 and 2018, respectively.

Mortality rate trends for hypertensive heart disease in the age ≥65 population accelerated after 2011, and heart failure AAMR trends switched from decreasing to increasing.

Finally, investigators found that the burden of years of potential life lost was greatest from ischemic heart disease, but disparities between black-white cases were driven by heart failure and hypertensive heart disease.

Their analysis showed that black decedents had a two-fold higher YPLL due to heart failure compared with white individuals.

Shah and team further acknowledged the implications that their study’s results have on policy and public health strategies.

“Ultimately, a comprehensive multilevel, multi-stakeholder approach focused on prevention of modifiable risk factors, adherence to evidence based secondary prevention strategies, and targeting of disproportionately burdened groups is urgently needed to curb worrisome trends in deaths from heart disease in the US,” they wrote.

The study, “Heterogeneous trends in burden of heart disease mortality by subtypes in the United States, 1999-2018: observational analysis of vital statistics,” was published online in The BMJ.