{
  "abstract": "Contemporary evidence on heart failure (HF) recorded as the underlying cause of death remains fragmented across demographic groups and levels of urbanization. The 2018-2023 interval includes two years before the emergence of COVID-19 (2018-2019) and four years after its emergence (2020-2023). We aim to characterize the national underlying cause of HF mortality among US adults aged 45 years or older from 2018 through 2023; describe differences by sex, age, race, and Hispanic origin; and quantify changes in absolute death counts across the six National Center for Health Statistics (NCHS) urbanization categories. We hypothesized that the national age-adjusted HF mortality rate would increase and that demographic differences and variation in geographic death counts would persist. This retrospective, population-based, serial cross-sectional study used Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) Underlying Cause of Death data (International Classification of Diseases, 10th Revision (ICD-10) I50). Age-adjusted mortality rates (AAMRs) per 100,000 were evaluated overall and across demographic groups; age-specific crude rates were used for age groups. Zero-joinpoint log-linear models estimated annual percent change (APC) for the overall population, race categories, and Hispanic-origin categories. Race and Hispanic origin were analyzed separately and may overlap. Urbanization analyses used death counts and percentage changes; urbanization-specific population-adjusted rates were not estimated. Deaths listing HF only as a contributing cause were outside the case definition. There were 512,960 deaths with HF as the underlying cause; the aggregate AAMR was 59.6 per 100,000. No statistically significant overall temporal trend was detected (APC: 0.59%; 95% confidence interval (CI): -0.37 to 1.57; p = 0.227). Men had a higher aggregate AAMR than women (68.1 versus 53.0), and Black adults had the highest racial AAMR (70.9). Asian adults had a lower aggregate AAMR than White and Black adults (22.9); Hispanic adults had a lower AAMR than non-Hispanic adults (35.2 versus 61.9). In their respective analyses, Asian and Hispanic groups had increasing trends at the nominal 0.05 significance level (APC: 1.30%, p = 0.047, and 1.96%, p = 0.030, respectively). Age-specific mortality increased sharply with age. Death counts increased across all six urbanization categories, most in Medium Metro counties (+11.0%). No statistically significant national trend was detected during 2018-2023, while descriptive demographic differences and nominally significant increases in the Asian race and Hispanic-origin analyses were observed. These separate analyses do not establish differences between subgroup slopes or narrowing mortality gaps. Geographic findings describe absolute burden, not population-adjusted risk. The results concern HF as the underlying cause and do not measure total HF-associated mortality.",
  "abstract_shown": true,
  "affiliations": [
    "Internal Medicine, Primary Care - Research Initiative (PCRI), Miami Lakes, USA.",
    "Cardiology, Primary Care - Research Initiative (PCRI), Miami Lakes, USA.",
    "Intensive Care Unit, Primary Care - Research Initiative (PCRI), Miami Lakes, USA.",
    "Geriatrics, Primary Care - Research Initiative (PCRI), Miami Lakes, USA.",
    "Internal Medicine, Iditalya 10 Medical Center, Tampa, USA.",
    "Primary Care, Primary Care - Research Initiative (PCRI), Miami Lakes, USA.",
    "Internal Medicine and Hematology, Primary Care - Research Initiative (PCRI), Miami Lakes, USA.",
    "Radiology, Primary Care - Research Initiative (PCRI), Miami Lakes, USA.",
    "Psychiatry, Larkin Community Hospital, Miami, USA.",
    "Clinical Research, Primary Care - Research Initiative (PCRI), Miami Lakes, USA.",
    "Research and Development, Tricocenter Miami, Miami Lakes, USA."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Andrew López Sánchez"
    },
    {
      "affs": [
        1
      ],
      "name": "Lissett Ferrer Orozco"
    },
    {
      "affs": [
        2
      ],
      "name": "Elmer D Perez Valdivia"
    },
    {
      "affs": [
        3
      ],
      "name": "Francisco J Santana Mercedes"
    },
    {
      "affs": [
        4
      ],
      "name": "Aitor J Roche Perez"
    },
    {
      "affs": [
        0
      ],
      "name": "Carmen Soler Martin"
    },
    {
      "affs": [
        5
      ],
      "name": "Gabriela Montano Diaz"
    },
    {
      "affs": [
        6
      ],
      "name": "Yanisleidy Valladares Urquiza"
    },
    {
      "affs": [
        7
      ],
      "name": "Javier Peña Angel"
    },
    {
      "affs": [
        8
      ],
      "name": "Dailyn Rivera Hernández"
    },
    {
      "affs": [
        0
      ],
      "name": "Mailyn Marrero Herrera"
    },
    {
      "affs": [
        9,
        10
      ],
      "name": "Carlos Acosta-Batista"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7js5y9xptfe19.bib",
  "cited_by": 0,
  "doi": "10.7759/cureus.117568",
  "fulltext_url": "https://europepmc.org/articles/PMC13739860",
  "id": "7js5y9xptfe19",
  "issns": [
    "2168-8184"
  ],
  "landing_url": "https://europepmc.org/article/MED/42996381",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2705|Heart Failure Treatment and Management"
    ]
  ],
  "openalex": "W7220651261",
  "pdf_url": "https://europepmc.org/articles/PMC13739860?pdf=render",
  "pmcid": "PMC13739860",
  "pmid": "42996381",
  "published": "2026-10-06",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/7js5y9xptfe19.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T15:20:41Z",
      "native_id": "MED:42996381",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42996381"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Heart Failure Treatment and Management",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Heart Failure Mortality Before and After COVID-19: Demographic Variations and Urbanization Patterns in the United States (2018-2023).",
  "title_text": "Heart Failure Mortality Before and After COVID-19: Demographic Variations and Urbanization Patterns in the United States (2018-2023).",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:41Z",
  "url": "https://research.draconitic.com/paper/7js5y9xptfe19",
  "venue": "Cureus",
  "versions": []
}