The study published in the Journal of the American Heart Association investigates the mortality rates in the U.S for ischemic heart disease (IHD) and other heart diseases between 1970 and 2022. Heart disease has been the leading cause of mortality for more than a century in the U.S. Targeted intervention, advancement in medical technology, and management of acute myocardial infarction (AMI) have significantly reduced mortality from IHD since the 1960s. Recent research recommends a rise in the mortality rate from other heart disorders like arrhythmias, heart failure, and hypertensive heart disease. This analysis provides a comprehensive perspective on historical achievement and offers a forward-looking strategy to direct future development. It validates the substantial effects and treatment innovation that have resulted in the reduction of mortality by IHD while investigating and giving explanations for the concurrent increase in mortality from other heart disease subtypes.
This study analyzed mortality data for adults aged 25 and older by using the National Vital Statistics System and the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. The International Classification of Diseases (ICD) codes were utilized to determine the underlying cause of mortality linked to heart disease from different versions of the coding system. The data extraction was dependent on AMI, IHD, and other heart diseases like pulmonary heart disease, cardiac arrest, arrhythmia, rheumatic heart disease, valvular heart disease, hypertensive heart disease, cardiomyopathy, heart failure, and other cardiac diseases. The study classified these cases as chronic IHD, as approximately 90% of other IHD-related deaths were associated with ICD-10 code I25 and corresponding ICD-9 and ICD-8 codes. Life expectancy and population size were derived from the CDC WONDER.
The Joinpoint Regression Program is used to calculate overall and interval percentage variation in the mortality rate of heart disease. A balanced average of yearly percentage variation was presented as average annual percentage changes (AAPCs) with 95% confidence intervals (CIs).
The U.S. population aged 25 and older increased from 108.9 million to 229 million, and life expectancy increased from 70.9 years to 77.5 years from 1970 to 2022. The National Vital Statistics System reported 119 million deaths, with heart disease leading to 37.3 million (31%) in 5 decades. Heart disease caused 733,273 deaths (41% overall), of which 91% were from IHD in 1970. Mortality rate from heart disease decreased to 701,443 (24% overall), but the breakdown changed 47% from other heart disease and 53% from IHD by 2022. AMI caused 54% and chronic IHD caused 46% deaths in 1970. In 2022, chronic IHD caused 71% and AMI caused only 29% deaths.
The age adjusted mortality rate decreased: AMI mortality rate decreased to 89% (40 from 354 in 100,000 with -4.2% AAPC, 95% CI -4.3 to -4.1), chronic OHD mortality rate reduced 81% (98 from 343 in 100,000 with -2.5 % AAPC, 95% CI -2.6 to -2.4), overall IHD mortality rate reduced to 81% (135 from 693 in 100,000 with -3.1% AAPC, 95% CI -3.2 to -3.1) and all heart disease mortality rate reduced to 66% (258 from 761 in 100,000 with -2.0% AAPC, 95% CI -2.1 to -2.0).
The mortality rate in other heart disease subtypes increased to 81% (123 from 68 in 100,000 with +1.2% AAPC): Hypertensive heart disease: 33 from 16 in 100,000 with +106%, heart failure: 32 from 13 in 100,000 with +146% and arrhythmias: 11 from 2 in 100,000 with +450%.
This study has some limitations, such as the use of many iterations of the ICD coding system, the need to maintain consistency, and potential miscoding. The study discovered that certain diseases like cardiomyopathy and heart failure can be oversimplified because of underlying ischaemic reasons. Potential variation in decreases by sex, age, race, area, ethnicity, and urbanization was noted by the research.
Heart disease mortality rates have reduced over the last 5 decades. There is an elevating burden from other heart diseases like arrhythmias, hypertensive heart disease, and heart failure. Further research must be done to solve the increasing challenge of these heart diseases.
Reference: King SJ, Wangdak Yuthok TY, Bacong AM, et al. Heart disease mortality in the United States, 1970 to 2022. J Am Heart Assoc. 2025:e038644. doi:10.1161/JAHA.124.038644
