Trends and disparities in ventricular tachycardia mortality in the United States

Abstract

We aimed to evaluate trends and disparities in mortality from ventricular tachycardia in patients with underlying cardiovascular disease. We performed cross‐sectional analyses using publicly available data from the Center for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research database. We identified a total of 7025 deaths from ventricular tachycardia between the years 2007 and 2020. Overall, age‐adjusted mortality rates increased from 0.22 in 1999 to 0.32 in 2020 (p < .05). Black female and male adults had higher age‐adjusted mortality rates compared to White female and male adults, respectively (p < .05). Disproportionate age‐adjusted mortality rates among male populations and Southern residents were also observed. This study demonstrated an increase in deaths related to ventricular tachycardia since 2007. Significant differences in mortality exist across racial, gender, and geographic subgroups.

Abbreviations

AAMR

age‐adjusted mortality rates

AAPC

average annual percentage change

CDC

Center for Disease Control and Prevention

CIs

confidence intervals

CVD

cardiovascular disease

ICD

International Classification of Diseases

VT

ventricular tachycardia

1.

Ventricular tachycardia (VT) remains a common cause of mortality in the United States in patients with underlying cardiovascular disease (CVD). Population‐level disparity research highlights areas that remain under‐recognized and aid in identifying gaps in healthcare equity. Therefore, we sought to quantify trends in mortality from VT in patients with underlying CVD and performed subgroup analyses.

This study uses publicly available and deidentified data from the Center for Disease Control and Prevention (CDC) Wide‐Ranging Online Data for Epidemiologic Research database to capture all deaths in the United States. ¹ Death certificates include the underlying cause of death and contributing causes of death. The underlying cause of death, defined by the World Health Organization, is described as the diagnosis that directly led or initiated the sequence of events that led to death. Contributing causes of death, defined by the CDC, are described as the diagnoses that have contributed to the death. All diagnoses are based on the International Classification of Diseases, Tenth Revision (ICD10). Institutional Review Board approval was not required as the data collected are available in the data repositories in a deidentified format. Mortality rates from VT (ICD10 code: I47.2) as the underlying cause of death in patients with CVD (ICD10 codes: I00–I78) as contributing causes of death were queried between 2007 and 2020. Age below 35 years and above 85 years were excluded, given the concern for congenital heart disease and poor demonstrated reliability of underlying cause of death reporting, respectively. ² Quantified measures included age‐adjusted mortality rates (AAMR), average annual percentage change (AAPC), and respective 95% confidence intervals (CIs). AAMR was calculated per 100 000 population and standardized to the US population in the year 2000. Subgroup analyses were completed using gender, race, age, National Center for Health Statistics urban–rural classification, and US census information. Joinpoint regression (National Cancer Institute) was used for trend analysis. Data visualization was done using statistical software (Stata Statistical Software: Release 17.0; StataCorp LLC).

There were a total of 7025 deaths in the United States from VT in patients with underlying CVD between the years 2007 and 2020. Yearly mortality rates are included in Supporting Information: Table S1. Death counts stratified by ICD10 subsets of the multiple causes of death files are described in Supporting Information: Tables S2 and S3. AAMR increased from 0.22 [95% CI, 0.20–0.24] in 2007 to 0.32 [95% CI, 0.29–0.34] in 2020 with an AAPC of +3.90% [95% CI, 2.8–5.0] (Figure 1). AAMR was disproportionately higher in Black adults (0.44 [95% CI, 0.41–0.47]) and in male adults (0.37 [95% CI, 0.36– 0.38]) compared to their counterparts, White adults (0.26 [95% CI, 0.25–0.27]) and female adults (0.20 [95% CI, 0.19–0.21]), respectively. AAPC among Black and White adults showed similar between‐group differences at +4.05% [95% CI, 2.6–5.5] and +3.19% [95% CI, 1.9–4.5], respectively. AAMR was higher in Black female and Black male adults (0.38 [95% CI, 0.31–0.37] and 0.63 [95% CI, 0.58–0.68], respectively) compared to White female and White male adults (0.20 [95% CI, 0.19–0.21] and 0.37 [95% CI, 0.36– 0.38], respectively). AAPC was greater among male adults (+4.98% [95% CI, 4.0–6.0]) compared with female adults (+1.98% [95% CI, 0.4–3.6]). AAMR was higher among older males (1.30 [95% CI, 1.26–1.35]) [65–84 years] and older females (0.60 [95% CI, 0.57–0.63]) [65–84 years] compared to younger males (0.10 [95% CI, 0.10–0.11]) [35–64 years] and younger females (0.08 [95% CI, 0.07–0.09]) [35–64 years], respectively.

Figure 1.

Trends in age‐adjusted mortality rates from ventricular tachycardia between 2007 and 2020 in decedents (A) aged 35–84 years and (B) stratified by race and gender.

There is a higher burden of VT‐related AAMR within Southern regions (0.31 [95% CI, 0.30–0.32]) compared to Northeastern (0.26 [95% CI, 0.25–0.28]) and Western regions (0.19 [95% CI, 0.18–0.20]) in the United States, with no differences between metropolitan (0.28 [95% CI, (0.27–0.29]) and nonmetropolitan (0.30 [95% CI, 0.28–0.32]) areas.

Our analysis found that overall VT‐related AAMR in patients with underlying CVD increased between 2007 and 2020, disproportionately affecting Black adults, males, and Southern residents. Despite a decrease in overall CVD‐related death in the United States, the increasing rate of mortality secondary to VT is coupled with the rapid increase in the population of adults aged 60 years and older, leading to a higher prevalence of associated structural and ischemic heart diseases. ³ A plausible hypothesis explaining our observed increase in VT mortality is increased recognition of VT as the primary cause of death. This could be driven by the increased prevalence of patients with cardiac implantable electronic devices such as pacemakers, loop recorders, and defibrillators, as well as the increased availability of wearable technology and outpatient rhythm monitoring devices.

The racial variability is likely attributable to differences in risk factors, social factors, and environmental factors. ⁴ Our study showed that males have a greater burden of VT‐related mortality, and this difference could be attributable to differences in the prevalence of ischemic heart disease and sex differences in susceptibility to sustained ventricular arrhythmias. ⁵

Variations in VT mortality among the US census regions are largely related to overall cardiovascular health and comorbidity burden. For example, Southern states have a higher comorbidity burden including obesity, diabetes mellitus, hypertension, and physical inactivity, in congruence with the increased VT mortality seen in our analysis. ⁶

Limitations to this analysis include the use of death certificates to identify the cause of death, which may be subjected to inaccuracies in reporting causes of death. Additionally, covariates such as VT subtype, duration, morphology, hemodynamic status, and VT treatment are not available in this database. However, these limitations are unlikely to explain the disparities. In conclusion, this study demonstrated an increase in deaths related to VT since 2007 and that significant differences exist across racial, gender, and geographic subgroups.

Supporting information

Supporting information.

Ibrahim R, Sroubek  J, Nakhla S, Lee JZ. Trends and disparities in ventricular tachycardia mortality in the United States. J Cardiovasc Electrophysiol. 2023;34:465‐467. 10.1111/jce.15812

DATA AVAILABILITY STATEMENT

The data that supports the findings of this study are available in the Supporting Information of this article. All data are publicly available in CDC WONDER Database.