AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Temporal Trends in Heart Failure Mortality Among Hispanic Females in the United States (1999-2023)
By Sapkota S, Khan SA, Sabesan V et al.
Background: Heart failure (HF) affects more than 7 million people in the United States. Hispanic women have historically demonstrated lower cardiovascular mortality despite a high burden of risk factors, a phenomenon described as the “Hispanic paradox.” However, recent evidence suggests this advantage may be diminishing, and national trends in HF mortality among Hispanic women remain poorly characterized. Hypothesis: We hypothesized that HF mortality among Hispanic women has increased over time, with disproportionate increases in younger women and variation across geographic regions. Methods: CDC WONDER data (1999-2023) were used to identify heart failure deaths (ICD-10 I50). Age-adjusted mortality rates per 100,000 were calculated using the 2000 U.S. standard population, and Joinpoint regression was used to estimate annual percent change (APC). Trends in Hispanic women were compared by sex, ethnicity, age, and region. Results: Among Hispanic women, 36,124 HF deaths were identified. AAMRs demonstrated a triphasic pattern: stability from 1999-2007 (APC, -0.09%; p=0.88), a nonsignificant decline from 2007-2010 (APC, -4.64%; p=0.17), and a significant increase from 2010-2023 (APC, 1.94%; 95% CI, 0.94-2.76; p=0.03), rising from 16.3 to 18.0 per 100,000. Women aged 25-64 years experienced a steeper increase from 2012-2023 (APC, 5.21%; 95% CI, 3.66-8.05; p<0.001), approximately fivefold greater than in women aged ≥65 years. Among Hispanic men, AAMRs increased from 18.2 to 23.3, although the temporal trend was not statistically significant. In contrast, mortality among non-Hispanic women remained stable (30.3 to 30.7), indicating narrowing ethnic differences. Regionally, significant increases were observed in the Northeast (APC, 3.22%; 2010-2023), West (APC, 3.13%; 2013-2023), and South (APC, 3.70%; 2020-2023). State-level AAMRs during 2021-2023 varied substantially, with the highest rates observed in Mississippi (26.6), Connecticut (26.4), and Hawaii (26.1). Conclusions: HF mortality among Hispanic women shifted from long-term stability to a significant increase beginning in 2010, with the steepest rise among women aged 25-64 years. In contrast, mortality remained stable among non-Hispanic women, suggesting attenuation of the Hispanic paradox. These findings highlight the need for age- and region-specific strategies to improve HF prevention, risk factor control, and equitable access to HF care in Hispanic women.