Introduction: Tobacco use disorder is associated with increased morbidity and mortality from heart failure (HF) in the United States. Despite this burden, long-term trends in HF mortality among tobacco users and the extent of demographic and geographic disparities remain poorly understood, limiting targeted prevention and intervention strategies. This study examines these trends and disparities using the CDC WONDER database. Methods: Mortality data from 2003 to 2020 were analyzed for individuals aged ≥25 years with tobacco use disorder who died from HF. Age-adjusted mortality rates (AAMRs) per 100 000 general population were calculated. Joinpoint regression estimated annual percentage changes. Subgroup analyses were conducted by sex, race/ethnicity, region, and rural–urban classification. Results: From 2003 to 2020, 576 781 HF deaths occurred among tobacco users aged ≥25 years. The overall AAMR nearly quadrupled during this period. Men consistently exhibited higher AAMRs than women. Among racial/ethnic groups, American Indians or Alaska Natives had the highest rates, followed by Whites, Blacks, and Asian or Pacific Islanders. Regionally, the Midwest recorded the highest mortality, followed by the South, Northeast, and West. Rural populations had higher AAMRs than urban populations. At the state level, Oregon showed the highest AAMR, while California had the lowest. Conclusion: The sharp rise in HF mortality among tobacco users underscores critical public health gaps. Disparities were most pronounced among men, American Indians or Alaska Natives, Midwestern residents, and rural populations. By identifying high-risk populations and regions, this study provides actionable insights to guide targeted interventions, tobacco cessation programs, and equitable healthcare access, helping to address the growing burden of HF in tobacco users.

Background: Acute heart failure (AHF) remains a major cause of morbidity and mortality, especially in hospitalized patients. Inotropic agents like dobutamine have long been used for hemodynamic support, yet concerns over adverse effects such as arrhythmias and increased myocardial oxygen consumption limit their safety. Levosimendan, a calcium sensitizer with vasodilatory properties, offers a potential alternative. This meta-analysis was conducted to evaluate the comparative safety and efficacy of levosimendan versus dobutamine in patients with AHF. Method: A systematic review and meta-analysis was conducted following PRISMA and AMSTAR 2 guidelines. Major databases including PubMed, Cochrane, Embase, and ScienceDirect were searched up to July 2025 without any language restrictions. Sixteen studies including 15 randomized controlled trials and 1 cohort study were evaluated for this study. Outcomes were pooled using a random effects model. Meta-regression was performed to assess the influence of baseline covariates. Result: In the pooled analysis of 16 studies, levosimendan showed a statistically significant reduction in mortality (RR: 0.59; P = 0.0009) compared to dobutamine. While systolic blood pressure and diastolic blood pressure remained comparable, levosimendan led to a marked reduction in pulmonary capillary wedge pressure and improved cardiac index, left ventricular ejection fraction, and mixed venous oxygen saturation. B-type natriuretic peptide and IL-6 levels also declined significantly in the levosimendan group. Adverse events such as hypotension and atrial fibrillation were slightly more frequent with levosimendan, while tachycardia and ischemic events were more common with dobutamine. Overall adverse event rates were similar. Conclusion: Levosimendan demonstrates favorable effects on mortality and key hemodynamic parameters in patients with AHF, especially those on β-blockers or with impaired left ventricular function. Although certain adverse effects like hypotension were more frequent, the overall safety profile remained comparable to dobutamine. These findings suggest levosimendan as a safer and more effective alternative in selected high-risk heart failure populations.

Heart failure (HF) and pneumonia are leading causes of mortality in the United States, yet limited research has examined deaths attributable to their co-occurrence. Understanding demographic and geographic disparities in these mortality trends is critical for guiding public health interventions. Using data from the CDC Wide-ranging Online Data for Epidemiologic Research database, this study analyzed mortality from 1999 to 2020 among individuals aged 25 years and older. Age-adjusted mortality rates (AAMRs) per 100 000 population were calculated by sex, race/ethnicity, region, and rural–urban classification, with temporal trends assessed via Joinpoint regression. A total of 542 805 deaths were attributed to HF and pneumonia. Mortality declined steadily from 1999 through 2019 but rose sharply thereafter. The overall AAMR was 11.4, consistently higher in men than in women. Racial and ethnic disparities were evident: White individuals had the highest AAMR (11.6), followed by Black (10.2), American Indian/Alaska Native (9.6), and Asian/Pacific Islander populations (6.5). Regionally, the Midwest had the highest rate (12.3), and rural areas (15.3) exceeded urban areas (10.5). State-level mortality was greatest in West Virginia, Kentucky, and Oklahoma. These findings highlight a reversal of declining trends and underscore persistent disparities, emphasizing the need for targeted prevention, improved healthcare access, and community-based interventions.

Background: Cardiac arrest (CA) is one of the main causes of death in the U.S., and its impact on the healthcare system may be associated with substance-use (SU) disorders through the interplay of metabolic and cardiotoxic mechanisms. Despite the extensive research on drug overdose-related mortality, the impact of drug use on mortality from CA has not been thoroughly examined. Methods: We utilized the CDC WONDER Multiple Cause of Death database (1999–2023) to extract mortality data related to CA and SU-related causes of death among individuals aged ≥25 years. Age-adjusted mortality rates (AAMRs) per 100 000 were computed. Temporal trends were assessed using Joinpoint to calculate annual percent changes (APCs) along with 95% confidence intervals. Rates were stratified by sex, race, age groups, region, and place of death. Results: A total of 163 384 deaths were identified from 1999 to 2023. The AAMR increased from 2.22 to 4.32, surging in 2021 after a period of sharp rise (APC 13.52%, 2018–2021), before dropping thereafter (APC −7.18%, 2021–2023). Compared with women, men consistently had higher mortality rates (mean AAMR men: 4.45 vs women: 1.52). The non-Hispanic (NH) American Indian/Alaskan Natives reported the highest AAMR (9.35), whereas NH Asian/Pacific Islanders had the lowest (0.93), depicting the racial disparities. Geographic variations were notable, with the West reporting the highest burden (5.13). Most fatalities (63.3%) occurred in healthcare facilities, followed by the decedents’ homes (25.78%), with lower proportions observed in other locations. Conclusion: These findings describe a growing burden of deaths with marked sex, racial/ethnic, and geographic differences that may inform targeted prevention and equitable care delivery.