(267) Cardiac Arrest-Related Mortality in the U.S., 1999-2021: Insights From the CDC-WONDER Database

Introduction: Cardiac arrest (CA) poses a substantial burden on the healthcare system, and is associated with significant morbidity and mortality. The trends and underlying causes of CA-related mortality in the US need to be investigated.

Methods: Using the CDC WONDER database, we identified CA-related deaths from 1999-2021 utilizing ICD-10-CM code I46. We used crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) of CA per 100,000 population to analyze mortality trends using Joinpoint Regression program version 5.0.2. We calculated annual percentage change (APC) and average annual percentage change (AAPC) for each analysis. Additionally, we conducted stratified analyses by gender, race, age, census region, rural-urban status, and underlying cardiovascular (CVD) causes of death.

Results: Between 1999 and 2021, a total of 8,150,550 CA-related deaths occurred in the US, out of which 4,011,217 (49.2%) deaths had CVD as the underlying cause. COVID-19 was responsible for 90,062 CA deaths between 2020 and 2021 (AAMR 12.47). The overall AAMR was 132.86 (95% CI: 132.43-133.30) in 1999 and decreased to 109.63 (95% CI: 109.30-109.96) in 2021. The AAMR decreased by 2.74% per year between 1999-2009 followed by a 0.80% decrease per year between 2009-2019. However, from 2019 to 2021 there was a large increase in the AAMR of CA (APC 9.80%; P < 0.05). These trends were largely consistent across the subgroups of gender, age, race, census region, and rural-urban status. When focusing only on CA deaths with CVD as the underlying cause, a decline in the AAMR was observed till 2019 after which it increased by 2.49% per year. The largest contributor to CA mortality was ischemic heart disease (IHD); however, it has been steadily declining since 1999. In contrast, other CVD causes of CA deaths such as hypertensive diseases and cerebrovascular diseases have been associated with an increasing trend over the past few years. Notably, the Northeast census region has shown a continuous decline in AAMR in contrast to other regions.

Conclusions: Although COVID-19 is a large contributor to the recent increase in CA-related mortality, most CVD causes except IHD have also shown a rising trend. Despite the recent advancements in CA care, CA remains a concerning source of mortality in the US.