Heart Failure–Related Mortality in Young Adults Saw Rapid Increase Since 2012

Muhammad Shahzeb Khan, MD, MSc

New findings suggest heart failure–related mortality in young adults had a rapid overall increase from 2012 to 2019 in the United States, following an initial period of stability.

The findings were consistent across all sex and racial and ethnic groups. However, data show that young Black adults had a 3-fold higher age-adjusted mortality rate in comparison to their Hispanic or White counterparts, with significant variation based on geography.

“Thus, although declines in cardiovascular mortality between the 1970s to 2010s could signal success of targeted health policy interventions, use of guideline-directed medical therapy, and better mitigation of clinical risk, these data from recent years suggest challenges with the continued successful implementation of these strategies,” wrote study author Muhammad Shahzeb Khan, MD, MSc, Division of Cardiology, Duke University School of Medicine.

Older adults make up the majority of those diagnosed with heart failure, but an increasing proportion of younger adults are said to be diagnosed in recent years. There is limited data regarding heart failure related mortality in these patients, making it important to quantify the scope of the issue to better inform health policy measures.

Khan and colleagues performed a retrospective cohort analysis using mortality data of young adults (15 - 44 years old) with heart failure listed as a contributing or underlying cause of death within the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database from January 1999 to December 2019.

They defined race and ethnicity groups as Hispanic, non-Hispanic Black/African American, or non-Hispanic White. They determined heart failure–related crude and age-adjusted mortality rates (AAMR) per 100,000 US population.

Investigators identified a total of 61,279 heart failure–related deaths among young adults between 1999 and 2019. From this population, 38,629 (62.0%) were men and 23,460 (38.0%) were women and 22,156 (35.9%) were Black, 6648 (10.8%) were Hispanic, and 30,145 (48.8%) were White.

The overall AAMR per 100,000 persons for heart failure in young adults increased from 2.36 in 1999 to 3.16 in 2019. Data show AAMR was stable from 1999 to 2012 (annual percent change [APC], -0.3%; 95% CI, -0.8 to 0.2) and saw a raise between 2012 and 2019 (APC, 5.0% [95% CI, 3.6 to 6.3]).

They additionally observed heart failure–related mortality increased in young men and women. The data show the AAMR in men increased from 2.82 in 1999 to 3.98 in 2019 and the AAMR in women increased from 1.87 in 1999 to 2.33 in 2019.

Moreover, the AAMR increased for all race and ethnicity groups. The report suggests Black adults had the highest AAMR that increased from 6.41 in 1999 to 8.58 in 2019, while AAMR for Hispanic and White adults increased from 1.62 to 2.04 and 1.83 to 2.45 over the same time period, respectively.

In regional subgroups, nonmetropolitan areas had the highest AAMR that increased from 3.22 in 1999 to 5.11 in 2019. Investigators similarly observed mortality rates increased in large and medium/small metropolitan areas during the study period.

They noted there were significant regional differences in the burden of heart failure–related mortality. States in the upper 90th percentile of heart failure–related mortality (Oklahoma, South Carolina, Louisiana, Arkansas, Alabama, and Mississippi) had a significant higher mortality burden compared to those in the bottom tenth percentile.

“Data suggest that the burden of comorbidities such as diabetes, hypertension, and obesity, and behavioral risk factors follow a similar geographical trend, and better public health awareness about these adverse health behaviors could help decrease the regional disparity in heart failure mortality among young adults,” Khan added.

The study, “Demographic and Regional Trends of Heart Failure–Related Mortality in Young Adults in the US, 1999 - 2019,” was published in JAMA Cardiology.