Trends in Mortality Attributed to Heart Failure Among Older Adults in Brazil, 2000-2024

Abstract

Background: Heart failure is a leading cause of death in older adults, but long-term population-based evidence from middle-income countries remains limited. We examined national and regional trends in mortality assigned to heart failure among Brazilian adults aged 60 years or older from 2000 to 2024. Methods: We conducted a nationwide, population-based time-series study using the Brazilian Mortality Information System. Deaths were included if the International Classification of Diseases, 10th Revision, code I50 was recorded as the underlying cause. Population denominators came from official census counts and intercensal estimates. We calculated crude, age-specific, and age-standardized mortality rates per 100,000 population using direct standardization to the age distribution of Brazilians aged 60 years or older in the 2022 census. Trends over 2000-2024 were estimated by weighted log-linear regression and expressed as annual percentage changes with 95% CIs. Regional heterogeneity was assessed with a calendar year-by-region interaction. Results: Between 2000 and 2024, 601,490 deaths were assigned to heart failure as the underlying cause among Brazilian adults aged 60 years or older. The age-standardized mortality rate declined from 157.4 per 100,000 in 2000 to 83.7 per 100,000 in 2024, a 47% reduction (annual percentage change −2.68%, 95% CI −2.96 to −2.41). Rates declined in both sexes, all age groups, and all macroregions. Declines were fastest in the Central-West and South and slowest in the North and Northeast (p < 0.001); the North had the highest regional rate in 2024. Despite falling rates, the annual number of deaths increased from 23,213 in 2000 to 27,909 in 2024. The post-2019 plateau persisted when the pandemic years were excluded. Conclusions: Mortality assigned to heart failure among older Brazilian adults declined markedly, but progress was uneven, and the absolute number of deaths rose as the population aged. Slower declines in the North and Northeast and the persistent burden among the oldest adults identify priorities for surveillance and health-system planning.