Heart disease and heart failure: Trends and disparities in mortality rates in the United States from 2000 to 2020.

Study objective: To describe the age, sex and racial disparities in mortality rates for heart disease (HD) and heart failure (HF) in the United States (US) between 2000 and 2020. Design: This was an ecological study with trend analysis of mortality rates. Setting: United States. Participants: Adults aged 18 years and above. Main outcomes measures: Mortality rates per 100,000 for HD and HF. Results: There was a significant decrease in the age-standardized mortality rate for HD over the past two decades (from 343.5 per 100,000 cases to 215.1 per 100,000 cases, p < 0.001). HD mortality rates were significantly higher in males (p < 0.001), non-Hispanic blacks (p < 0.001) and in adults aged 65+ (p < 0.001) and 75+ (p < 0.001). There was no significant change in the age-standardized mortality rate for HF (from 26.9 per 100,000 cases to 25.7 per 100,000 cases (p = 0.706)) due to a reversal in the trend beyond 2011. Though the HF mortality rates were significantly lower in males (p = 0.001), and not significantly different in non-Hispanic blacks and non-Hispanic whites, there were shifts in trends beyond 2016, with higher rates in males and in non-Hispanic blacks compared to non-Hispanic whites. Conclusions: In summary, this study underscores significant reductions in heart disease mortality rates over the past two decades, alongside persistent disparities among different demographic groups. It also highlights emerging trends in heart failure mortality rates in particular population subgroups in recent years, necessitating further exploration to inform targeted interventions and policies.