Heart failure-related mortality in leukemia patients: A 26-year United States surveillance study (1999–2024).

Abstract

257 Background: Heart failure (HF) is a recognized comorbidity in leukemia patients, driven by cardiac dysfunction and treatment-related cardiotoxicity. This study examines longitudinal trends and demographic and geographic disparities in HF-related mortality among leukemia patients to inform cardio-oncology care. Methods: Mortality data from CDC WONDER (1999–2024) for adults ≥25 years were analyzed using ICD-10 codes C91.0–C95.7 (leukemia) and I11.0, I13.0, I13.2, I50.0, I50.1, and I50.9 (HF). AAMRs per 100,000 were stratified by year, sex, race/ethnicity, and geography. Joinpoint regression estimated APC and AAPC with 95% CIs; p < 0.05 was considered significant. Results: A total of 50,479 deaths were identified, occurring most commonly in inpatient settings (Table 1). Overall AAMR increased modestly from 0.93 (95% CI: 0.89–0.98) in 1999 to 1.07 (1.03–1.11) in 2024 (AAPC: 1.45%; p = 0.36). Two trend segments were identified: a significant decline from 1999 to 2011 (APC: −2.33%; 95% CI: −2.81 to −1.85), followed by a significant increase through 2021 (APC: 10.67%; 95% CI: 2.83–19.15). Adults aged 65–85+ had the highest burden (AAMR: 4.10). Males had higher 2024 AAMRs than females (1.61 vs. 0.69). NH White patients had the highest 2024 AAMR (1.26), followed by NH Black (0.85) and Hispanic/Latino (0.41) patients. The Midwest had the highest 2024 AAMR (1.32) and the Northeast the lowest (0.89). Non-metropolitan areas had higher AAMRs than metropolitan areas (1.25 vs. 0.97 through 2020). At the state level, North Dakota recorded the highest AAMR from 1999–2020 (1.51), while Minnesota was highest from 2021–2024 (2.13). Conclusions: HF-related mortality among leukemia patients rose significantly after 2011, with disproportionate burden among older men, NH White patients, and those in non-metropolitan and Midwestern areas. These findings identify populations where cardio-oncology resources should be prioritized. Deaths and age-adjusted mortality rates (AAMRs) per 100,000 for heart failure in patients with leukemia, 1999–2024. Variable Deaths AAMR (95% CI), 1999 AAMR (95% CI), 2024 Overall 50,479 0.93 (0.89–0.98) 1.07 (1.03–1.11) Male 28,860 1.26 (1.17–1.35) 1.61 (1.54–1.69) Female 21,619 0.75 (0.70–0.80) 0.69 (0.65–0.73) NH Black 3,276 0.67 (0.54–0.82) 0.85 (0.74–0.97) NH White 44,783 1.00 (0.95–1.05) 1.26 (1.21–1.31) Hispanic/Latino 1,632 0.31 (0.19–0.47) 0.41 (0.33–0.49) Midwest 13,512 1.03 (0.93–1.12) 1.32 (1.23–1.41) Northeast 9,094 0.90 (0.80–1.00) 0.89 (0.81–0.97) Metropolitan* 29,909 0.87 (0.82–0.92) 0.97 (0.93–1.01)* Non-metropolitan* 8,872 1.19 (1.07–1.30) 1.25 (1.14–1.35)* NH = Non-Hispanic. AAMRs per 100,000, age-adjusted to the 2000 U.S. standard population. *Urbanization data available through 2020 only.