Trends and Disparities in Ventricular Tachycardia-Related Mortality According to Cardiomyopathy Type in the United States.

The “modern” era of the treatment of ventricular tachyarrhythmias with device-based therapy may have begun in 1899, when Prevost and Battelli noted, almost as an afterthought, that direct current shock could terminate ventricular fibrillation (VF) in dogs.1 Three decades later, pioneering work in the field of defibrillation concluded that the passage of electrical current across the heart can both initiate and terminate VF.2,3 Still, little attention was paid to this phenomenon, as evidenced by Paul Dudley White’s Heart Disease , which devoted less than half a page to VF and characterized the arrhythmia as “a condition of little importance so far as we know now.”4 In 1947, the thoracic surgeon Claude Beck saved the first human life by the successful use of cardiac defibrillation in a 14-year-old boy who developed VF during a thoracic surgical procedure and went on to achieve a full recovery.5 These early accomplishments provided the foundation for the landmark work of Mirowski and Mower that ultimately led to the development of the implantable cardioverter-defibrillator (ICD) and its introduction in humans in 1980.6 Pacing may prevent sudden cardiac death due to bradyarrhythmias and in certain circumstances such as torsade de pointes associated with congenital long-QT syndrome (LQTS) and pause-dependent ventricular tachycardia (VT). Although no controlled studies exist, retrospective analyses suggest that recurrent torsade de pointes in patients with LQTS may be prevented by continuous pacing.7 Early clinical data on small numbers of patients suggested that the combination of β-adrenergic blockade plus continuous pacing reduced the number of syncopal events and the anticipated rate of sudden death in high-risk LQTS patients.8 The beneficial effects of pacing may be limited to patients with LQT2 and LQT3, in which the transmural dispersion of repolarization worsens steeply during bradycardia.9 Genotype-phenotype correlation confirms that …

RACIAL DISPARITIES IN PULMONARY EMBOLISM RISK FACTORS AND MORTALITY IN THE UNITED STATES: 1999-2020

e18517 Background: Leukemia, a hematological malignancy, ranks as the sixth leading cause of cancer-related deaths in males and seventh in females in the U.S. Advances in treatments, including tyrosine kinase inhibitors, monoclonal antibodies, and CAR T-cell therapy, have improved survival rates. However, limited research has examined leukemia as a contributing cause of death or its trends in the post-COVID-19 era. This study evaluates U.S. leukemia mortality trends from 1999 to 2022, focusing on disparities by sex, race, and region, and comparing leukemia as an underlying versus contributing cause of death. Methods: Mortality data from the CDC WONDER system were analyzed for leukemia listed as the underlying and contributing cause of death. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated, standardized to the 2000 U.S. population, and stratified by sex, race, and region. Joinpoint regression was used to analyze trends and annual percent changes (APCs). Statistical significance was defined as p < 0.05. Results: Between 1999 and 2022, 383,730 leukemia deaths were reported as the underlying cause and 474,481 as a contributing cause. AAMRs for underlying-cause deaths declined from 5.3 (95% CI: 5.2–5.4) in 1999 to 4.5 (95% CI: 4.5–4.6) in 2022 (APC = -0.79%, p < 0.001). Contributing-cause AAMRs also declined from 6.9 (95% CI: 6.7–7.1) in 1999 to 5.8 (95% CI: 5.7–5.9) in 2018 (APC = -0.68%, p < 0.001), but reversed post-2018, rising to 6.1 (95% CI: 6.0–6.2) by 2022 (APC = 2.43%, p = 0.006). Males consistently had higher AAMRs than females. In 1999, male and female AAMRs were 6.8 (95% CI: 6.7–7.0) and 4.0 (95% CI: 3.9–4.1), respectively, declining to 4.3 (95% CI: 4.1–4.3) and 3.2 (95% CI: 3.1–3.3) by 2022. Whites had the highest AAMRs (5.3 in 1999 to 4.5 in 2022, APC = -0.81%, p < 0.001), while American Indian/Alaska Natives had the lowest (2.5 in 1999 to 1.6 in 2022, APC = -1.47%, p < 0.001). Geographic disparities persisted, with the Midwest reporting the highest underlying-cause AAMRs (5.5 in 1999 to 4.7 in 2022, APC = -0.77%, p < 0.001). Notably, Contributing-cause AAMRs in the South and West increased significantly post-2018 (APC = 3.32%, p < 0.01; APC = 3.20%, p < 0.01). Conclusions: The decline in underlying-cause AAMRs highlights advancements in leukemia treatment. The increase in contributing-cause mortality post-2018 suggests a growing comorbidity burden, possibly influenced by COVID-19. Continued surveillance and targeted interventions are vital to address disparities and improve outcomes.

Although multi-detector computed tomography (MDCT) and cardiac magnetic resonance (CMR) can assess the structural substrate of ventricular tachycardia (VT) in ischemic cardiomyopathy (ICM), non-ICM (NICM), and arrhythmogenic right ventricular cardiomyopathy (ARVC), the usefulness of systematic image integration during VT ablation remains undetermined. A total of 116 consecutive patients (67 ICM; 30 NICM; 19 ARVC) underwent VT ablation with image integration (MDCT 91%; CMR 30%; both 22%). Substrate was defined as wall thinning on MDCT and late gadolinium-enhancement on CMR in ICM/NICM, and as myocardial hypo-attenuation on MDCT in ARVC. This substrate was compared to mapping and ablation results with the endpoint of complete elimination of local abnormal ventricular activity (LAVA), and the impact of image integration on procedural management was analyzed. Imaging-derived substrate identified 89% of critical VT isthmuses and 85% of LAVA, and was more efficient in identifying LAVA in ICM and ARVC than in NICM (90% and 90% vs. 72%, P < 0.0001), and when defined from CMR than MDCT (ICM: 92% vs. 88%, P = 0.026, NICM: 88% vs. 72%, P < 0.001). Image integration motivated additional mapping and epicardial access in 57% and 33% of patients. Coronary and phrenic nerve integration modified epicardial ablation strategy in 43% of patients. The impact of image integration on procedural management was higher in ARVC/NICM than in ICM (P < 0.01), and higher in case of epicardial approach (P < 0.0001). Image integration is feasible in large series of patients, provides information on VT substrate, and impacts procedural management, particularly in ARVC/NICM, and in case of epicardial approach.

42 Background: Colorectal cancer (CRC) has witnessed a decrease in incidence and mortality in the United States (US) for the past few decades likely due to increased screening and improvements in treatment . Despite the overall burden of CRC has declined and survival has been made for older adults, there is a simultaneous and alarming increase in CRCs diagnosed in individuals younger than 50 years of age. These Early Onset CRC (EOCRC) which now account for roughly 10% of new CRC cases in the US. The purpose of this study was to assess the trends and regional differences in EOCRC-related mortality among adults in the United States. Methods: Death certificates from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) database were examined from 1999 to 2020 for -related mortality in adults &lt;45 years of age. Age-adjusted mortality rates (AAMRs) per 10,000 persons and annual percent change (APC) were calculated and stratified by year, sex, race/ethnicity, and geographic region. Results: Between 1999 and 2020, 32,850 EOCRC-related deaths occurred among adults 25-44 years. The AAMR increased from 2.1 in 1999 to 2.6 in 2020. Men had consistently higher AAMR than women from 1999 (AAMR men: 2.0 vs women: 1.6) to 2020 (AAMR men: 2.6 vs women: 2.0). Non Hispanic (NH) African Americans had the highest overall AAMR (3.1), followed NH White (2.2), NH Asians (1.6) and Hispanics (AAMR 1.5) Caucasians have had a significant increase in mortality over the past 2 decades ( APC 1.4 (95%Cl 1.1-.7)) whereas the Hispanics have shown an APC of 4 (95% Cl 2.3-5.8 from 2012-2020). AAMR also varied substantially by region (overall AAMR: Midwest 2.1; South: 2.4; West: 1.9; Northeast: 2.0). States in the top 90th percentile of EOCRC-related AAMR were Mississippi, Arkansas, Oklahoma, South Carolina, Alabama West Virginia, Louisiana ,Kentucky and Tennessee which had approximately double the AAMRs compared with states that fell into the lower 10th percentile. Conclusions: EOCRC-related mortality in U.S. adults has been steadily increasing over the past two decades . The highest AAMRs were observed among African American adults and men, and among patients living in the Southern , Midwestern regions and those living in the nonmetropolitan United States. Targeted strategies are needed to prevent and treat EOCRC among older adults to curb increasing levels of EOCRC-related mortality.

Trends and Disparities of Chronic Lymphocytic Leukemia Mortality in the United States from 1999 to 2020

Introduction: In the United States (US), malignancy and cardiovascular disease (CVD) make up the majority of the burden of chronic diseases, leading to greater morbidity and mortality. As the general population grows older, the prevalence of these two disease entities are likely to increase. Efforts in cardio-oncology have been focused on disease prevention and treatment, however, little is known about existing disparities in this population. Hypothesis: Unequivocal burden of CVD-related mortality exists among certain gender, racial, and geographic subgroups. Methods: Data was obtained from the CDC Wide-ranging Online Data for Epidemiologic Research database using death certificate information from the National Vital Statistics system. All CVD-related death (I00 - I78) as the underlying cause of death in individuals with malignancy (C00 - C97) as the multiple causes of death were queried from 1999 - 2020. Underlying cause of death was defined as the disease that directly led to death and the multiple causes of death were defined as the diseases that contributed to death. Quantified measures included age-adjusted mortality rate (AAMR) per 100,000 population, 95% confidence intervals, and average annual percentage change (AAPC). Joinpoint regression (National Cancer Institute) was utilized for trend analysis and AAPC calculation. Results: There was a total of 595,446 deaths between 1999 and 2020. The AAMR in 1999 was 24.85 which decreased to 12.811 by 2020 (p &lt;0.05), with an AAPC of -3.1%. Males (23.14) had a higher AAMR compared to females (11.05) (p &lt;0.05), and AAPC for both males and females were -3.4%. AAMR was disproportionately higher in non-Hispanic populations (16.26) compared to Hispanic populations (9.17) (p &lt;0.05), with similar AAPC (-3.1% and -3.0%, respectively [p &gt;0.05]). Black individuals (18.87) had the highest AAMR, followed by White individuals (15.81), American Indian/Alaska Native individuals (9.40), and Asian/Pacific Islander individuals (8.26) (p &lt;0.05). All AAPC for the racial subgroups were similar (-3.3%, -3.1%, -2.7%, and -4.1%, respectively [p &gt;0.05]). Non-metro regions (17.20) had higher AAMR compared to metro regions (15.54) (p &lt;0.05) with an AAPC of -2.4 and -3.3%, respectively (p &gt;0.05). The Northeast (17.93) had the highest AAMR, followed by similar AAMR in the Midwest (16.44) and West (16.30) regions, and then South regions (13.98) (p &lt;0.05). AAPC was similar among all US census regions (-3.6%, -3.3%, -3.4%, and -2.8%, respectively [p &gt;0.05]). Conclusion: Even with decreasing rates of AAMR from 1999 to 2020, there remains a disproportionate burden of AAMR among gender, racial, and geographic subgroups. Continued efforts targeted at mitigating CVD-related mortality in patients with underlying malignancy is warranted.

e19087 Background: Pulmonary embolism (PE) is a significant complication and a marker of increased mortality in patients suffering from hematolymphoid malignancies, including leukemias, lymphomas, and multiple myeloma. Individuals with these hematologic cancers are at an increased risk of venous thromboembolism (VTE) due to cancer-associated hypercoagulability, treatment-related effects, and disease-related factors. Examining mortality trends is critical for informing targeted interventions and optimizing patient management. Methods: This retrospective study analyzes national mortality data from the CDC WONDER database to assess mortality trends from 1999 to 2020 across different demographic subgroups in the United States. Patients with a known history of a hematolymphoid cancer were identified and PE related mortality data was retrieved. Age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated and further stratified based on sex, age, race and census region. Rstudio was used to perform the t-test and Mann Kendall test. Results: From 1999 to 2020, a total of 12,453 deaths were reported in hematolymphoid cancer associated PE in the US (females, AAPC: 0.17 (95% CI: 0.165-0.175) vs. males AAPC: 0.256 (95% CI: 0.25-0.263)). The overall AAMR demonstrates a general upward trend with some annual fluctuations, increasing from 0.409 in 1999 to 1.022 in 2020. AAMR declined from 1999 to around 2009, reaching its nadir (τ: -0.160, p=0.321 for females, τ: 0.105, p=0.516). From 2010 onwards, a gradual increase is observed, with a sharp spike in 2020. Men consistently had a higher AAMR than women, with rates of 0.166 vs. 0.261 in 1999 and 0.223 vs. 0.31 in 2020. Black or African American females had higher AAMRs (0.228) than White females (0.164). Males followed a similar trend (0.356 vs. 0.261). AAMR also varied significantly by region, with the Midwest having the highest rate (0.219), followed by Northeast (0.214). For the age group of 16-64 years, males had consistently higher AAMR (0.065), than females (0.034), with an overall AAMR of 0.047 (p&lt;0.001). Similar trends were seen for the age group older than 65 years (1.28 vs 0.819), which also demonstrated a higher overall AAMR (1.059) (p&lt;0.001). In summary, Black or African American males of the age group 65+ had the highest AAMR. Conclusions: Our analysis of hematolymphoid malignancy-associated pulmonary embolism highlights a concerning increase in this near-fatal cancer-related complication, particularly after 2010, with the highest impact observed among male Black or African American patients and those residing in the Midwest region. These findings emphasize the urgent need for healthcare programs to focus on these vulnerable populations by implementing enhanced screening protocols, lowering the diagnostic threshold for PE in patients with hematolymphoid malignancies.

The aging population in the USA has led to a concomitant rise in the prevalence of vascular dementia (VaD), yet there remains a paucity of investigation into mortality trends associated with VaD among adults. This cross-sectional analysis utilized death certificate data from the Centers for Disease Control and Prevention's WONDER database. VaD-associated mortality was identified using the International Statistical Classification of Diseases and Related Health Problems-10th revision (ICD-10) code F01. Crude, and age-adjusted VaD-associated mortality rates per 100,000 and their corresponding 95% confidence intervals (CI) were computed. Age-adjusted mortality rates (AAMRs) were standardized to the 2000 US census population. From 2005 to 2020, there were 375,575 deaths attributed to VaD among older adults. We observed a gradual increase in AAMR (APC: 3.70, 95% CI [-4.14, 5.21]) from 2005 to 2015, succeeded by a pronounced escalation (APC: 9.07, 95% CI [6.09, 17.62]) until 2020. The highest AAMR was noted in the West (17.65, 95% CI [17.55, 17.76]), followed by the Midwest (AAMR: 12.66, 95% CI [12.58, 12.75]), the South (AAMR: 12.60, 95% CI [12.54, 12.67]), and the Northeast (AAMR: 8.60, 95% CI [8.53, 8.68]). Metropolitan areas exhibited higher AAMRs (10.9, 95% CI [10.8, 11.0]) compared to non-metropolitan areas (8.1, 95% CI [8.00, 8.3]). Among age groups, individuals aged 75-85 and older showed the highest overall AAMR (99.80, 95% CI [99.47, 100.14]). In addition, non-Hispanic Black or African-American subset of the population showed the highest overall AAMR (8.12, [95% CI: 8.03, 8.20]). Our findings underscore the imperative for targeted public health interventions aimed at addressing regional disparities and age-specific vulnerabilities to mitigate the mounting burden of VaD-related mortality.

e23307 Background: The Asian and Pacific Islander (API) population is the fastest growing in the United States, composing nearly 7% of the US population. Although cancer is the second leading cause of death overall in the U.S., it is the leading cause of death in the API population. Despite this, no study has assessed trends in cancer mortality in API individuals in the US. Our aim was to analyze differences and trends in API cancer mortality in the U.S. between 1999 to 2020. Methods: The CDC WONDER database was used to determine mortality statistics for patients, classified as non-Hispanic Asian or Pacific Islander, with cancer (ICD-10 codes C00-C97) as the underlying cause of death between 1999 and 2020. Age-adjusted mortality rates (AAMR) were calculated per 100,000 deaths, and were stratified by cancer type, sex, population density, U.S. census region, and age. Joinpoint regression software was used to identify temporal trends. Average annual percent change (APC) was considered statistically significant if p &lt; 0.05. Results: Between 1999 and 2020, cancer accounted for 305,386 deaths in API individuals. During this period, there was a 30% decrease in mortality due cancer and a decrease in APC of -1.5% (p &lt; 0.05). When stratified by cancer site, the largest decrease in APC was in stomach cancer at -3.7% (p &lt; 0.05), and the largest increase was in uterine cancer at 2.6% (p &lt; 0.05). In 1999, males experienced an overall cancer-related AAMR of 151, 48% higher than females at 103; however, by 2020 these differences reduced, with males having a cancer-related AAMR of 105.6 vs API females of 80.9, a 25% difference. Males experienced a larger decrease in APC (-1.8%, p &lt; 0.05), compared with females (-1%, p &lt; 0.05). Rural populations had the largest cancer-related AAMR (113.0) and largest drop in APC (-2%, p &lt; 0.05), compared with urban groups with a cancer-related AAMR of 106.7 and APC drop (-1.3%, p &lt; 0.05). The highest cancer related AAMRs was seen in lung cancer (24.3 in urban vs 25.4 in rural). Liver-cancer related AAMR was highest in urban populations at 10.4 and lowest in rural populations at 8.2. Western census regions had the highest AAMR at 113.7 with an APC decrease of –1.4% and Southern census regions had the lowest AAMR at 90.5 with an APC decrease of –1.2%. Adults aged &gt; 65 experienced the highest cancer related AAMR at 588.2, and adults aged 25-44 demonstrated the lowest AAMR at 14.7. However, adults aged 25-44 experienced the largest decrease in APC at -2% (p &lt; 0.05), compared with adults aged &gt; 65 at -1.4% (p &lt; 0.05). Conclusions: Our study identifies a significant decrease in cancer mortality in API individuals between 1999 and 2020. The largest decrease seen was in stomach cancer; however, uterine cancer mortality has increased. Notably, liver cancer mortality was higher in urban rather than rural groups. Further studies may examine differences amongst API and other racial groups, and potential sources for the disparities seen amongst API individuals.

Temporal Trends in Rural vs Urban Sepsis-Related Mortality in the United States, 2010-2019

Introduction Valvular heart disease and chronic kidney disease are significant causes of mortality in the U.S. Their evolving trends remain underexplored in recent decades. We aim to analyze the mortality trends of valvular heart disease and chronic kidney disease from 1999-2020. Research Question: What are the temporal trends in mortality from valvular heart disease and chronic kidney disease in the United States from 1999 to 2020 across demographic and geographic subgroups? Methods: Death certificates from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) database were examined from 1999 to 2020. Crude mortality rate (CMR) and age adjusted mortality rate (AAMR) per 1,000,000 were calculated and stratified by sex, race/ethnicity, age groups, regions, and states. Temporal trends were described by calculating annual percent change (APC) and average APC (AAPC) in the rates using Joinpoint regression analysis Results: From 1999-2020, a total of 50319 deaths related to valvular diseases and chronic kidney disease among adults aged 25+. An overall increasing mortality trend was observed from 7.13 in 1999 to 13.57 in 2020 (AAPC: 3.33; 95% CI: 2.11 to 4.77; p &lt;0.000001). Males had a higher overall AAMR (14.38) than females (8.17). Highest AAMR was observed in NH Black/African American (11.98), followed by NH American Indians (10.98), NH White (10.54), Hispanics/Latinos (7.83), and NH Asians (7.78). Among regions, highest mortality rate was found in West (12.25), followed by Midwest (11.57), Northeast (10.63), and South (8.78). States in the top 90 th percentile were Oregon (20.07), followed by Vermont (19.26), Washington (19.18), Minnesota (18.21), and Wisconsin (15.07). Rural had a higher AAMR (11.12) than urban (10.42). Highest number of deaths took place in Medical Facility- inpatient (49.64%). Highest CMR was observed in 85+ years. Conclusion There has been a significant increase in mortality associated with both valvular heart disease and chronic kidney disease. These trends highlight the urgent need for ongoing surveillance and targeted public health strategies to reduce the burden of these chronic cardiovascular and renal conditions.

82 * Ablation of ventricular tachycardia in the very elderly with cardiomyopathy

Introduction Parkinson’s disease (PD) is the most common neurodegenerative movement disorder and is associated with significant disability. The prevalence of PD is increasing and the literature demonstrates potential sex and race disparities in patient outcomes. There is a paucity of data about the demographic trends in PD-related mortality in the United States (US). This descriptive study aimed to report the national demographic trends in PD-related mortality over a 20-year period. Methods From January 1999 to December 2020, the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC-WONDER) Underlying Cause of Death database was queried. Data were extracted to determine the PD-related age adjusted mortality rate (AAMR) stratified by age, sex, ethnicity and geographic area, with the 1999 deaths as the reference group. Annual percentage change (APC) for AAMR was then calculated using Joinpoint regression. Results From 1999 to 2020, there were 515,884 PD-related deaths in the study period. AAMR increased from 5.3 per 100,000 population in 1999 to 9.8 per 100,000 in 2020. Males had consistently higher AAMR than females and white race had consistently higher overall AAMR (7.6 per 100,000), followed by American Indians/Alaska Natives (4.4 per 100,000), Asians/Pacific Islanders (4.1 per 100,000) and Black/African Americans (3.4 per 100,000). The Midwest had the highest AAMR followed by West, South and Northeast. Utah, Idaho and Minnesota had the highest state-level AAMR. Conclusion This study using a national dataset identified significant age, sex, race and geographic disparities in PD-related mortality in the US. Older age, male sex, white race and Midwest locality were associated with the highest AAMR.

Parkinson's disease (PD) is the most common neurodegenerative movement disorder and is associated with significant disability. The prevalence is rising, and studies have reported potential sex and race disparities in patient outcomes. Data about the demographic trends in PD-related mortality in the United States (US) is limited. This descriptive study aimed to report the national demographic trends in PD-related mortality over a 20-year period. The US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC-WONDER) Underlying Cause of Death database from January 1999 to December 2020 was used to determine the PD-related age adjusted mortality rate (AAMR) stratified by age, sex, ethnicity and geographic area, with the 1999 deaths as the reference group. Annual percentage change (APC) for AAMR was then calculated using Joinpoint regression. There were 515,884 PD-related deaths in the study period. The AAMR increased from 5.3 per 100,000 population in 1999 to 9.8 per 100,000 in 2020. Males had consistently higher AAMR than females and white race had consistently higher overall AAMR (7.6 per 100,000), followed by American Indians/Alaska Natives (4.4 per 100,000), Asians/Pacific Islanders (4.1 per 100,000) and Black/African Americans (3.4 per 100,000). The Midwest had the highest AAMR followed by West, South and Northeast. Utah, Idaho and Minnesota had the highest state-level AAMR. This study identified significant age, sex, race and geographic disparities in PD-related mortality in the US. Older age, male sex, white race and Midwest locality were associated with the highest AAMR.