Data driven insights into heart failure mortality in rheumatoid arthritis: unveiling the cardiac burden: a two decade epidemiological study

Abstract Introduction Rheumatoid arthritis (RA) doubles heart failure (HF) risk, contributing to high cardiovascular mortality in RA patients. Despite RA being linked to twice the HF incidence versus the general population, mechanisms remain unclear, and mortality trends in RA-HF patients are understudied. Purpose Analyze U.S. mortality trends (1999–2020) in RA-HF patients to identify high-risk groups and guide public health strategies. Methods CDC WONDER mortality data (ICD-10: HF=I50, I11.0, I13.0, I13.2; RA=M05, M06) were used. Age-adjusted mortality rates (AAMRs/1,000,000) calculated with 2000 U.S. standard population. Joinpoint regression estimated annual percent changes (APCs); significance (P0.05) determined via 95% CIs. Demographics (sex, age, race), geography (region, state, urban-rural), and place of death were assessed for adults ≥35 years (STROBE-compliant). Results From 1999–2020, 31,036 deaths occurred (AAMR:8.33). Mortality declined until 2009 (APC=−4.50, CI:−5.17–−3.81), then gradually until 2018 (APC=−0.71, CI:−1.73–0.32), before sharply rising (APC=11.60, CI:2.66–21.33). Females had higher AAMR (10.2) than males (5.4), with both showing initial declines followed by increases (males:2016, APC=4.49, CI:−0.38–9.60; females:2018, APC=12.80, CI:3.46–22.99). The 80–84 age group had the highest crude mortality (53.51). Racial disparities: American Indian/Alaskan Natives had highest AAMR (13.73), followed by non-Hispanic (NH) Whites (8.82), NH Blacks (8.71), and Asian/Pacific Islanders (2.91). Geographically, the Midwest had the highest AAMR (10.48), followed by West (9.30), South (7.43), and Northeast (6.34). North Dakota (18.57) and Nevada (3.15) had the highest and lowest state-level AAMRs, respectively. Non-core rural areas had the highest AAMR (12.07) versus large central metros (6.26). Most deaths occurred in medical facilities (10,291). Conclusion RA-HF mortality declined until 2020 but rose recently, notably among females and older adults. Persistent racial, geographic, and urban-rural disparities emphasize the need for equitable interventions to mitigate mortality.