Post-Acute Myocardial Infarction Heart Failure-Related Mortality Trends Among Adults in the United States, 1999-2024: A CDC WONDER Analysis

Presenter: FNU Laiba.

Despite advances in reperfusion and secondary prevention, heart failure (HF) remains a major complication of acute myocardial infarction (MI), affecting up to one-third of patients, yet national trends in post-MI HF mortality are incompletely characterised. Using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database, this study analysed age-adjusted mortality rates (AAMRs) among US adults aged ≥25 years from 1999 to 2024. AAMR fell from 15.3 to 7.5 per 100,000 between 1999 and 2018, rose from 2018 to 2021 (annual percentage change [APC] 5.18%) to 8.9 per 100,000, and then declined through 2024 (APC -4.82%). Overall, mortality decreased significantly (average annual percentage change [AAPC] -2.84%, 95% confidence interval [CI]: -3.37 to -2.31; p<0.001). Men had consistently higher mortality than women, Black or African American individuals the highest rates, and adults aged ≥65 years the highest age-specific rates, whereas mortality rose after 2012 in adults aged 25-44 years (APC 6.47%). Non-metropolitan areas, the South and the Midwest had higher rates. Despite overall progress, these persistent disparities by sex, race, age, geography and urbanisation call for targeted interventions.

Preadmission Beta-Blocker Therapy and Short-Term Outcomes After CABG in Acute Coronary Syndrome Patients with Preserved Ejection Fraction: A Propensity-Matched Analysis

Presenter: Ahmed Rafek Aghazawy.

Preadmission beta-blocker therapy is considered cardioprotective in acute coronary syndromes (ACS), but its independent contribution to short-term outcomes in patients with preserved ventricular function undergoing coronary artery bypass grafting (CABG) is unclear. This retrospective study included 1,060 ACS patients with preserved ejection fraction (EF ≥40%) undergoing isolated CABG, comparing those on preadmission beta-blockers (BB+, n=560) with beta-blocker-naïve patients (BB–, n=500). In-hospital (0.6% vs 0.3%) and 30-day mortality (1.3% vs 0.6%) were similar, and after multivariable adjustment beta-blocker therapy was not independently associated with in-hospital (odds ratio [OR] 1.53, 95% confidence interval [CI] 0.12-18.96; p=0.742) or 30-day mortality (OR 2.48, 95% CI 0.62-9.91; p=0.198). In 311 propensity-matched pairs, mortality, median hospital length of stay (9.0 days in both groups; p=0.929) and intensive care unit stay (40.7 vs 44.1 hours; p=0.871) remained comparable. Preadmission beta-blockade thus conferred no independent perioperative survival benefit; the authors attribute the numerically higher BB+ mortality to confounding by indication and caution against using these findings to withhold therapy.

Beta-Blockers After Myocardial Infarction Without Reduced Ejection Fraction: A Contemporary Randomized Evidence Meta-Analysis

Presenter: Ahmed Elmorsy Mohamed.

In the contemporary reperfusion era, the role and duration of beta-blocker therapy after myocardial infarction (MI) in patients without reduced left ventricular ejection fraction remain uncertain. This meta-analysis pooled six randomised trials including 26,064 patients, comparing beta-blocker use or continuation with no use or withdrawal after MI in patients without reduced ejection fraction or heart failure. Beta-blocker therapy was not associated with a significant reduction in major adverse cardiovascular events (MACE) (hazard ratio 0.93; 95% confidence interval [CI], 0.84-1.03), all-cause mortality (risk ratio [RR] 1.00; 95% CI, 0.89-1.13), cardiovascular mortality (RR 1.09), recurrent MI (RR 0.89; 95% CI, 0.77-1.03), stroke (RR 1.24) or heart failure hospitalisation (RR 0.84; 95% CI, 0.67-1.04), with no interaction by treatment strategy. Bayesian analyses suggested higher posterior probabilities of benefit for MACE, recurrent MI and heart failure hospitalisation, and trial sequential analysis crossed benefit boundaries for MACE and recurrent MI. Mortality therefore appears neutral, while uncertainty persists for MACE and recurrent MI, supporting individualised rather than routine use of beta-blockers in this population.

American Heart Association (AHA) Scientific Sessions 2026, November 6–9, Chicago, Illinois