Introduction: Rheumatic heart disease (RHD) is a preventable disease which affects almost 33 million people globally. RHD was estimated to be responsible for 305,000 deaths worldwide and 11.5 million disability-adjusted life years lost in 2015. We investigated the temporal trends of RHD related mortality in the U.S. by using nationwide data. Methods: Death certificate data were retrieved from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (WONDER) database for 1999-2018. WONDER database reports the underlying cause of death across the United States. Mortality for Rheumatic heart disease ICD-10 (I05-I09) which includes rheumatic mitral valve diseases I05; rheumatic aortic valve diseases I06; rheumatic tricuspid valve diseases I07; multiple valve diseases I08; or other rheumatic heart disease I09; as an underlying cause of death were queried from 1999-2018. This study duration was further stratified into five-year periods. Crude mortality rate and age-adjusted mortality rate per 100,000 were calculated with a 95% confidence interval in four U.S census regions. Results: Overall AAMR showed a downward trajectory and declined from 1.3 to 0.9 per 100,000 from 1999 to 2018. AAMR for Northeast (CR-1) declined by 33%; for Midwest (CR-2) declined by 23%; for South declined by 27%, and for West (CR-4) declined by 33%. Crude mortality rate, AAMR, and % deaths are shown in table 1.Temporal trends are illustrated in figure 1. Conclusions: Regional AAMRs for U.S census regions showed a downward trajectory from 1999-2018. These trends suggest the efficacy of of primary and secondary prevention of rheumatic heart disease.