Increasing HF-Related Mortality Concerning Among Young Adults, Experts Say

In the 7-year period of 2012 to 2019, death attributed to heart failure (HF) rose among young adults aged 15 to 44 years, with this concerning trend having experts calling for revisions to targeted health policy measures on 3 fronts: prevention, early diagnosis, and reducing disparities.

This new study was published recently in JAMA Cardiology, and the investigators’ full retrospective cohort analysis considered HF as either a contributing or underlying cause of death (HF, cardiovascular disease, ischemic heart disease, hypertension, cerebrovascular disease, diabetes, congenital malformation of the circulatory system) among this patient population from 1999 to 2019. They retrieved their data from the CDC’s Wide-Ranging Online Data for Epidemiologic Research database.

“There are limited data on mortality trends in young adults with HF,” the study authors wrote. “Given the potential economic burden stemming from the loss of productivity years and health care utilization that may be associated with HF mortality at a young age, it is important to quantify the magnitude of the problem to inform health policy measures.”

Most of the deaths in this analysis (N = 61,729) occurred among men (68.0%) and patients of a White ethnicity (48.8%), followed by patients reporting a Black (35.9%) or Hispanic (10.8%) ethnicity. Medical facilities (62.0%) were the most common location of death, and hospice, the least common (1.5%).

With the primary study outcome being age-adjusted mortality rate (AAMR) per 100,000 population, this jumped approximately 34% overall for the entire study period among all participants: from 2.36 in 1999 to 3.16 in 2019. The overall mean was 2.47. However, Black patients had exponentially higher AAMRs at the start and end of the study compared with White and Hispanic patients:

• 1999:
  • Black patients: 6.41
  • Hispanic patients: 1.83
  • White patients: 1.62
• 2019:
  • Black patients: 8.58
  • Hispanic patients: 2.45
  • White patients: 2.04

Men, overall, had a higher AAMR throughout the study period vs women—3.04 vs 1.87—the authors wrote. This can be seen in their AAMR increase from 2.82 to 3.89 vs 1.87 to 2.33 among women from 1999 to 2019, but this was even higher among Black adults compared with White or Hispanic adult patients, at 6.77 vs 1.91 vs 1.51, respectively.

For the first 3 years of the study, there had been a slight decrease in AAMR (annual percent change [APC], -0.3%; 95% CI, -0.8% to 0.2%), but that changed from 2012 to 2019, which saw an APC of 5.0% (95% CI, 3.6%-6.3%). Nonmetropolitan areas had the largest AAMR increase, with large and small/medium areas seeing similar jumps, and the HF-related mortality burden was higher in states in the upper 90th percentile (Oklahoma, South Carolina, Louisiana, Arkansas, Alabama, Mississippi) compared with states in the bottom 10th percentile (Rhode Island, Wisconsin, Connecticut, Vermont, Massachusetts, New Hampshire, Minnesota).

“While this recent increase in HF mortality is likely in part driven by the rising incidence of cardiometabolic risk factors and HF incidence among young adults, other factors may have played a part in increased reporting of HF on death certificates,” the authors concluded. “Targeted health policy measures are needed to address the rising burden of HF in young adults, with a focus on prevention, early diagnosis, and reduction in disparities.”

This is because successful implementation of strategies to improve outcomes among these patients has been challenging, and “young adults may be more susceptible to the health effects of being uninsured or underinsured because the United States lacks a safety net health coverage for adults younger than 65 years.”

Reference

Jain V, Minhas AMK, Morris AA, et al. Demographic and regional trends of heart failure–related mortality in Young Adults in the US, 1999-2019. JAMA Cardiol. 2022;7(9):900-904. doi:10.1001/jamacardio.2022.2213