Heart failure–related mortality in patients with breast cancer: A 26-year national surveillance study (1999–2024).

Abstract

43 Background: Heart failure (HF) is a recognized comorbidity in breast cancer patients, affecting both survival and quality of life. This study examines longitudinal trends and demographic and geographic disparities in HF-related mortality over 25 years to inform cardio-oncology care. Methods: CDC WONDER mortality data (1999–2024) were analyzed for women ≥25 years using ICD-10 codes C50 (breast cancer) and I11.0, I13.0, I13.2, and I50 (HF). AAMRs per 100,000 were stratified by race/ethnicity, age, and geography. Joinpoint regression estimated APC and AAPC with 95% CIs; p < 0.05 was considered significant. Results: A total of 72,361 deaths were identified, occurring primarily at home (31.83%) (Table 1). Overall AAMR declined marginally from 2.63 (95% CI: 2.53–2.72) in 1999 to 2.57 (2.49–2.65) in 2024 (AAPC: −0.01; p = 0.95). Two distinct trend segments were identified: a significant decline through 2014 (APC: −3.46; p < 0.001), followed by a significant increase through 2024 (APC: 5.40; p < 0.001). Women aged 65–85+ years had the highest burden (AAMR: 9.44). NH Black women had the highest 2024 AAMR (3.54), compared to NH White (2.68) and Hispanic/Latino (1.39) women. The Midwest had the highest 2024 AAMR (2.80) and the Northeast the lowest (2.13). Non-metropolitan areas had higher AAMRs than metropolitan areas (2.55 vs. 2.11 through 2020). At the state level, Mississippi recorded the highest average AAMR from 1999–2020 (3.34) and remained highest from 2020–2024 (5.14). Conclusions: After more than a decade of decline, HF-related mortality in breast cancer patients has risen sharply since 2014, with persistent disparities among older women, NH Black patients, and those in non-metropolitan and Midwestern areas. These findings identify populations where targeted cardio-oncology interventions are most needed. Deaths and age-adjusted mortality rates (AAMRs) per 100,000 for heart failure in patients with breast cancer, 1999–2024. Variable Deaths AAMR (95% CI), 1999 AAMR (95% CI), 2024 Overall 72,361 2.63 (2.53–2.72) 2.57 (2.49–2.65) NH Black 8,474 2.85 (2.50–3.19) 3.54 (3.25–3.85) NH White 59,963 2.68 (2.58–2.79) 2.68 (2.59–2.78) Hispanic/Latino 2,666 1.37 (1.05–1.75) 1.39 (1.21–1.59) Northeast 13,675 2.44 (2.24–2.64) 2.13 (1.97–2.30) Midwest 18,753 3.24 (3.02–3.45) 2.80 (2.62–2.99) Metropolitan* 44,920 2.48 (2.38–2.58) 2.11 (2.03–2.19)* Non-metropolitan* 12,170 3.23 (2.99–3.48) 2.55 (2.35–2.75)* NH = Non-Hispanic. AAMRs per 100,000, age-adjusted to the 2000 U.S. standard population. *Urbanization data available through 2020 only.