Ischemic heart disease vs. venous thromboembolism: a nationwide mortality trend analysis (1999–2020)
S Waqas, M Ismail, K Arshad, M Alrayyashi, L Gunaseelan, H Abu Daya, W AbidAbstract
Background
Ischemic heart disease (IHD) and venous thromboembolism (VTE), including pulmonary embolism, remain major causes of mortality in the United States. While IHD mortality has steadily declined due to advances in prevention and treatment, VTE-related mortality has remained relatively stable, with concerns about potential increases driven by aging, comorbidities, and acute infections.
Purpose
To analyze and compare age adjusted mortality trends for ischemic heart disease (IHD) and venous thromboembolism/pulmonary embolism (VTE/PE) in the United States from 1999 to 2020, and to assess the impact of the COVID 19 pandemic on these trends.
Methods
We obtained mortality data from the CDC WONDER database. Age-adjusted mortality rates (per 100,000 population) for IHD and VTE/PE were analyzed from 1999 to 2020. Age adjusted rate standard errors were calculated to assess variability. Trends over time were examined to identify significant changes, including the impact of the COVID-19 pandemic in 2020.
Results
The mortality trends for IHD and VTE & PE from 1999 to 2020 show distinct trajectories. IHD mortality has shown a consistent decline over two decades. The age adjusted rate decreased to 132.6 per 100,000 in 2019 from 249.4 per 100,000 in 1999 . This constitute a 46.8% reduction over 21 years. The most significant decreases occurred In 2003 and 2004 (6.4%), 2008 and 2009 (5.9%) which indicates periods of accelerated improvement. in 2020 Data showed an increase in mortality to 148.2 per 100,000 which is 11.8% increase from the previous year, potentially due to the impact of the COVID-19 pandemic. This turnaround indicates that pandemic related factors like as delayed healthcare access, increased cardiovascular complications from COVID-19 and lifestyle disruptions likely contributed to it. Mortality related to VTE and PE was stable during 1999 to 2019, ranging in between 11.6 and 12.4 per 100,000. The standard error was low as 0.1 which indicates reliable data points with minimal variability. Although, there was a remarkable increase in 2020 to 15.2 per 100,000 which represent a 22.6% increase from 2019. This sudden increase in mortality reaffirm the well known association between COVID-19 and increased risk of thromboembolic events. The significant increment in VTE/PE mortality highlights the need for further investigation into pandemic related risk factors, including hyper coagulability, immobility, and delays in seeking medical care.
Conclusions
The constant decline in IHD related mortality over two decades reflects successful prevention and treatment strategies, on other hand relatively constant mortality related to VTE/PE indicates a need for better prevention and early detection. Significant increase during COVID 19 reflects infection related complications and healthcare disruptions which requires to improve cardiovascular care access, optimize anticoagulation strategies and address modifiable risk factors in high risk populations.Image 1For image description, please refer to the figure legend and surrounding text.