Cardiogenic shock and acute renal failure associated mortality trends in the United States: a retrospective analysis of death records from 1999 to 2023

Abstract Background Cardiogenic shock (CS) and Acute Renal Failure (ARF) have a compounding impact on patient survival. The long-term epidemiological burden of this cardiorenal comorbidity remains understudied despite the advances in mechanical circulatory support and critical care. We aimed to analyze nationwide mortality trends and disparities involving co-occurring CS and ARF in the United States. Methods Death records from the CDC WONDER database were analyzed retrospectively (1999–2023), including adults aged ≥ 45 years listing CS and ARF as underlying or contributing causes. Age-Adjusted Mortality Rates (AAMRs) per 1,000,000 population were standardized to the 2000 U.S. population. Temporal trend assessment and annual percent changes (APCs) were computed through the Joinpoint regression program. Results A total of 48,926 deaths were identified with AAMR, increasing significantly from 7.0 in 1999 to 43.5 in 2023. Rates showed a steady incline from 2005 to 2019 (APC: 7.78), followed by a sharp acceleration from 2019 to 2023 (APC: 24.16). Males exhibited mortality rates nearly double those of females (20.5 vs. 10.5). Non-Hispanic (NH) African Americans had the highest AAMR (20.7) among racial groups. Geographically, the West (17.1) and non-metropolitan regions (12.9) experienced the highest mortality burdens. Conclusions The past two decades marked the surge in CS and ARF-related mortality rates following a sharp acceleration since 2019. Persistent disparities among males, NH African Americans, and rural populations highlight the urgent need for targeted resource allocation and improved access to advanced cardiorenal therapies. Clinical trial number Not applicable.