Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

Abstract

Background:

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

Methods:

The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year’s worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year’s edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy.

Results:

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

Conclusions:

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Summary

Each year, the American Heart Association (AHA), in conjunction with the National Institutes of Health and other government agencies, brings together in a single document the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors in the AHA’s My Life Check−Life’s Simple 7 (Figure),1 which include core health behaviors (smoking, physical activity [PA], diet, and weight) and health factors (cholesterol, blood pressure [BP], and glucose control) that contribute to cardiovascular health (CVH). The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions. Cardiovascular disease (CVD) produces immense health and economic burdens in the United States and globally. The Statistical Update also presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure [HF], valvular heart disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). Since 2007, the annual versions of the Statistical Update have been cited >20 000 times in the literature.

Each annual version of the Statistical Update undergoes revisions to include the newest nationally representative available data, add additional relevant published scientific findings, remove older information, add new sections or chapters, and increase the number of ways to access and use the assembled information. This year-long process, which begins as soon as the previous Statistical Update is published, is performed by the AHA Statistics Committee faculty volunteers and staff and government agency partners. Below are a few highlights from this year’s Statistical Update. Please see each chapter for references, CIs for statistics reported below, and additional information.

Cardiovascular Health (Chapter 2)

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A report pooled NHANES (National Health and Nutrition Examination Survey) 2011 to 2016 data and individual-level data from 7 US community-based cohort studies and estimated that 70.0% of major CVD events in the United States were attributable to low and moderate CVH; 2.0 million major CVD events could potentially be prevented each year if all US adults attain high CVH; and even a partial improvement in CVH scores to the moderate level among all US adults with low overall CVH could lead to a reduction of 1.2 million major CVD events annually.

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The large number of individuals in the United States who contracted severe illness because of coronavirus disease 2019 (COVID-19) resulted in a huge mortality toll. As of March 2021, the cumulative number of COVID-19 deaths in the United States was ≈545 000, which equates to ≈166 cases per 100 000 people, with higher rates of deaths occurring among US counties with metropolitan areas (≈185 deaths per 100 000), with a high percentage (>45.5%) of the population that is non-Hispanic (NH) Black (≈200 deaths per 100 000), with a high proportion (>37%) of the population that is Hispanic (≈219 deaths per 100 000), or with a high percentage (>17.3%) of the population that are living in poverty (≈211 deaths per 100 000 people).

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Because of the high COVID-19 mortality rates, life expectancy in the United States for the year 2020 has been estimated to decline with disproportionate impacts on populations with high COVID-19 mortality rates. Provisional US life expectancy estimates for January to June 2020 indicate that between 2019 and the first half of 2020, life expectancy decreased from 74.7 to 72.0 years for NH Black individuals, from 81.8 to 79.9 years for Hispanic individuals, and from 78.8 to 78.0 years for NH White individuals.

Smoking/Tobacco Use (Chapter 3)

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The prevalence of cigarette use in the past 30 days among middle and high school students in the United States was 1.6% and 4.6%, respectively, in 2020.

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Although there has been a consistent decline in adult and youth cigarette use in the United States in the past 2 decades, significant disparities persist. Substantially higher tobacco use prevalence rates are observed in American Indian/Alaska Native adults and youth and lesbian, gay, and bisexual adults.

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Over the past 9 years, there has been a sharp increase in electronic cigarette use among adolescents, increasing from 1.5% to 19.6% between 2011 and 2020; electronic cigarettes are now the most commonly used tobacco product in this demographic.

Physical Activity and Sedentary Behavior (Chapter 4)

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According to nationwide self-reported PA (YRBSS [Youth Risk Behavior Surveillance System], 2019), the prevalence of high school students who engaged in ≥60 minutes of PA on at least 5 days of the week was 44.1% and was lower with each successive grade (from 9th [49.1%]–12th [40.0%] grades).

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From nationwide self-reported PA (NHIS, 2018), the age-adjusted proportion who reported meeting the 2018 aerobic PA guidelines for Americans was 54.2%.

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An umbrella review of 24 systematic reviews of adults ≥60 years of age concluded that those who are physically active are at a reduced risk of CVD mortality (25%–40% risk reduction), all-cause mortality (22%–35%), breast cancer (12%–17%), prostate cancer (9%–10%), and depression (17%–31%) while experiencing better quality of life, healthier aging trajectories, and improved cognitive functioning.

Nutrition (Chapter 5)

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Data from the Nurses’ Health Study (1984–2014) and Health Professionals Follow-up Study showed that daily intake of 5 servings of fruit and vegetables (versus 2 servings/d) was associated with 13% lower total mortality, 12% lower CVD mortality, 10% lower cancer mortality, and 35% lower respiratory disease mortality.

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NHANES data and meta-analyses of prospective cohort studies show that higher intakes of total fat, polyunsaturated fatty acids, and monounsaturated fatty acids are associated with lower total mortality. However, the evidence for saturated fatty acid intake as a risk or protective factor for total and CVD mortality remains controversial.

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Meta-analytic evidence from randomized clinical trials does not support vitamin D supplementation for improving cardiometabolic health in children and adolescents between 4 and 19 years of age.

Overweight and Obesity (Chapter 6)

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From NHANES data, the overall prevalence of obesity and severe obesity in youth 2 to 19 years of age increased from 13.9% to 19.3% and 2.6% to 6.1% between 1999 to 2000 and 2017 to 2018. Over the same period, the prevalence of obesity and severe obesity increased from 14.0% to 20.5% and from 3.7% to 6.9% for males and from 13.8% to 18.0% and from 3.6% to 5.2% for females.

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From NHANES data, among adults, from 1999 to 2000 through 2017 to 2018, the prevalence of obesity among males increased from 27.5% to 43.0% and severe obesity increased from 3.1% to 6.9%. The prevalence of obesity among females increased from 33.4% to 41.9% and severe obesity from 6.2% to 11.5%.

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Significant increases in the prevalence of obesity were seen between 1999 to 2000 through 2017 to 2018 in all age-race and ethnicity groups except for NH Black males, in whom the prevalence increased from 1999 through 2006.

High Blood Cholesterol and Other Lipids (Chapter 7)

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In 2015 to 2018, unfavorable lipid measures of low-density lipoprotein cholesterol ≥130 mg/dL were present in 6.1% of male adolescents and 3.0% of female adolescents 12 to 19 years of age, triglycerides ≥130 mg/dL were present in 9.7% of male adolescents and 6.6% of female adolescents, and high-density lipoprotein cholesterol measures <40 mg/dL were present in 18.4% of male adolescents and 7.4% of female adolescents.

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In 2015 to 2018, total cholesterol ≥200 mg/dL was present in 38.1% of adults, low-density lipoprotein cholesterol ≥130 mg/dL was present in 27.8% of adults, triglycerides ≥150 mg/dL were present in 21.1% of adults, high-density lipoprotein cholesterol <40 mg/dL was present in 17.2% of adults.

High Blood Pressure (Chapter 8)

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From 2009 to 2019, the death rate attributable to high BP increased 34.2%, and the actual number of deaths attributable to high BP rose 65.3%.

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The 2019 age-adjusted death rate attributable primarily to high BP was 25.1 per 100 000 people. Age-adjusted death rates attributable to high BP (per 100 000 people) in 2019 were 25.7 for NH White males, 56.7 for NH Black males, 23.1 for Hispanic males, 17.4 for NH Asian/Pacific Islander males, 31.9 for NH American Indian/Alaska Native males, 20.6 for NH White females, 38.7 for NH Black females, 17.4 for Hispanic females, 14.5 for NH Asian/Pacific Islander females, and 22.4 for NH American Indian/Alaska Native females.

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In an analysis of 18 262 adults ≥18 years of age with hypertension (defined as 140/90 mm Hg) in NHANES, the estimated age-adjusted proportion with controlled BP increased from 31.8% in 1999 to 2000 to 48.5% in 2007 to 2008, remained relatively stable at 53.8% in 2013 to 2014, but declined to 43.7% in 2017 to 2018.

Diabetes (Chapter 9)

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In NHANES 2015 to 2018, an estimated 28.2 million adults (10.4%) had diagnosed diabetes, 9.8 million adults (3.8%) had undiagnosed diabetes, and 113.6 million adults (45.8%) had prediabetes.

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In NHANES 2003 through 2016, among adults with diagnosed and undiagnosed diabetes, the proportion taking any medication increased from 58% in 2003 through 2004 to 67% in 2015 through 2016, with an increase in the use of metformin and insulin analogs and decrease in sulfonylureas, thiazolidinediones, and human insulin.

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In NHANES 1988 through 2018, among adults with newly diagnosed type 2 diabetes, there was a significant increase in the proportion of individuals with hemoglobin A1c <7% (59.8% for 1998–1994 and 73.7% for 2009–2018) and decreases in mean hemoglobin A1c (7.0% and 6.7%), mean BP (130.1/77.5 and 126.0/72.1 mm Hg), and mean total cholesterol (219.4 and 182.4 mg/dL). The proportion with hemoglobin A1c <7.0%, BP <140/90 mm Hg, and total cholesterol <240 mg/dL improved from 31.6% to 56.2%.

Metabolic Syndrome (Chapter 10)

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In the HELENA study (Healthy Lifestyle in Europe by Nutrition in Adolescence) among 1037 European adolescents 12.5 to 17.5 years of age, those with mothers with low education showed a higher metabolic syndrome (MetS) risk score (β estimate, 0.54) compared with those with highly educated mothers. Adolescents who accumulated >3 disadvantages (defined as parents with low education, low family affluence, migrant origin, unemployed parents, or nontraditional families) had a higher MetS risk score compared with those who did not experience disadvantage (β estimate, 0.69).

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In HCHS/SOL (Hispanic Community Health Study/Study of Latinos), socioeconomic status was inversely associated with prevalent MetS among Hispanic/Latino adults of diverse ancestry groups. Higher income and education and full-time employment status versus unemployed status were associated with a 4%, 3%, and 24% decreased odds of having MetS, respectively. The association with income was significant only among females and those with current health insurance.

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In combined analysis from ARIC (Atherosclerosis Risk in Communities) and JHS (Jackson Heart Study), among 13 141 White and Black individuals with a mean follow-up of 18.6 years, risk of ischemic stroke increased consistently with MetS severity z score (hazard ratio [HR], 1.75) for those above the 75th percentile compared with those below the 25th percentile. Risk was highest for White females (HR, 2.63), although without significant interaction by sex and race.

Adverse Pregnancy Outcomes (Chapter 11)

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Adverse pregnancy outcomes (including hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and small for gestational age at birth) occur in 10% to 20% of pregnancies.

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Among 2304 female-newborn dyads in the multinational HAPO study (Hyperglycemia and Adverse Pregnancy Outcome), lower CVH (based on 5 metrics: body mass index, BP, cholesterol, glucose, and smoking) at 28 weeks’ gestation was associated with a higher risk of preeclampsia; adjusted relative risks were 3.13, 5.34, and 9.30 for females with ≥1 intermediate, 1 poor, or ≥2 poor (versus all ideal) CVH metrics during pregnancy, respectively.

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In analyses of Swedish national birth register data (>2 million–>4 million individuals), gestational age at birth was inversely associated with the risks for type 1 diabetes, type 2 diabetes, hypertension, and lipid disorders among individuals born preterm versus term.

Kidney Disease (Chapter 12)

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Overall prevalence of chronic kidney disease (estimated glomerular filtration rate <60 mL·min−1·1.73 m−2 or albumin-to-creatinine ratio ≥30 mg/g) was 14.9% (2015–2018).

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Age-, race-, and sex-adjusted prevalence of end-stage renal disease in the United States was 2242 per million people (in 2018) with highest rates among Black adults followed by American Indian/Alaska Native adults, Asian adults, and White adults.

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Medicare spent $81 billion caring for people with chronic kidney disease and $49.2 billion on those with end-stage renal disease in 2018.

Sleep (Chapter 13)

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In data from the 2014 BRFSS (Behavioral Risk Factor Surveillance System), 11.8% of people reported a sleep duration ≤5 hours, 23.0% reported 6 hours, 29.5% reported 7 hours, 27.7% reported 8 hours, 4.4% reported 9 hours, and 3.6% reported ≥10 hours. Overall, 65.2% met the recommended sleep duration of ≥7 hours.

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Analysis of the UK Biobank study (N=468 941) found that participants who reported short sleep (<7 h/d) or long sleep (>9 h/d) had an increased risk of incident HF compared with normal sleepers (7–9 h/d). In males, the adjusted HR was 1.24 for short sleep and 2.48 for long sleep. In females, the adjusted HR was 1.39 for short sleep and 1.99 for long sleep.

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A meta-analysis of 15 prospective studies observed a significant association between the presence of obstructive sleep apnea and the risk of cerebrovascular disease (HR, 1.94).

Total Cardiovascular Diseases (Chapter 14)

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In the Cardiovascular Lifetime Risk Pooling Project among 30 447 participants from 7 US cohort studies, among individuals ≥60 years of age with low CVH, the 35-year risk of CVD was highest in White males (65.5%), followed by White females (57.1%), Black females (51.9%), and Black males (48.4%). These estimated risks accounted for competing risks of death caused by non-CVD causes.

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In a meta-analysis of 14 studies that focused on CVD among individuals diagnosed with COVID-19, preexisting CVD had a relative risk of 2.25 for death resulting from COVID-19.

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In 2020, ≈19 million deaths were attributed to CVD globally, which amounted to an increase of 18.7% from 2010.

Stroke (Cerebrovascular Diseases) (Chapter 15)

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In the Greater Cincinnati Northern Kentucky Stroke Study, sex-specific ischemic stroke incidence rates declined significantly between 1993 to 1994 and 2015 for both males and females. In males, there was a decline from 282 to 211 per 100 000. In females, the decline was from 229 to 174 per 100 000. This trend was not observed for intracerebral hemorrhage or subarachnoid hemorrhage.

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In the Northern Manhattan Study, among 3298 stroke-free participants followed up through 2019, Black and Hispanic females ≥70 years of age had higher risk of stroke compared with White females after controlling for age, sex, education, and insurance status (Black females/White females: HR, 1.76; Hispanic females/White females: HR, 1.77). This increased risk was not present among elderly Black or Hispanic males compared with White males.

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Among adults treated for hypertension in an ambulatory setting in the United States, tight BP control (<130 mm Hg) was associated with a 42% lower incidence of stroke compared with standard BP control (130–139 mm Hg).

Brain Health (Chapter 16)

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A systematic analysis of data from the GBD study (Global Burden of Disease) showed that, in 2017, Alzheimer disease/Alzheimer disease and related dementia was the fourth most prevalent neurological disorder in the United States (2.9 million people). Among neurological disorders, Alzheimer disease/Alzheimer disease and related dementia was the leading cause of mortality in the United States (38 deaths per 100 000 population per year) ahead of stroke.

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In 2017, Alzheimer disease/Alzheimer disease and related dementia had the fifth leading incidence rate of neurological disorders in the United States according to the GBD study data. The US age-standardized incidence rate of Alzheimer disease/Alzheimer disease and related dementia was 85 cases per 100 000 people).

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In a meta-analysis of 12 randomized controlled trials (>92 000 participants; mean age, 69 years; 42% females), BP lowering with antihypertensive agents, compared with control, was associated with a lower risk of incident dementia or cognitive impairment (7.0% versus 7.5% of patients over a mean trial follow-up of 4.1 years; odds ratio [OR], 0.93; absolute risk reduction, 0.39%).

Congenital Cardiovascular Defects and Kawasaki Disease (Chapter 17)

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The 2017 all-age prevalence of congenital cardiovascular defects in the United States was estimated at 466 566 individuals, with 279 320 (60%) of these under the age of <20 years of age. The 2017 global prevalence of congenital cardiovascular defects was estimated at 157 per 100 000 people. with the highest prevalence estimates in countries with a low sustainable development index (238 per 100 000 people) and the lowest in those with a high-middle or high sustainable development index (112 and 135 per 100 000 people, respectively).

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Congenital cardiovascular defects appear to be more common among infants born to mothers with low socioeconomic status. In Ontario, mothers who lived in the lowest-income neighborhoods had higher risk of having an infant with a congenital cardiovascular defect compared with mothers living in the highest-income neighborhoods (OR, 1.29). Furthermore, this discrepancy between low and high was also found across measures of neighborhood education (OR, 1.34) and employment rate (OR, 1.18).

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Since May 2020, the Centers for Disease Control and Prevention has been tracking reports of multisystem inflammatory syndrome in children. As of June 28, 2021, 4196 cases and 37 attributable deaths (0.89%) have been reported. Median age of cases was 9 years; 62% of cases have occurred in children who are Hispanic or Latino (1246 cases) or Black (1175 cases); 99% tested positive for severe acute respiratory syndrome coronavirus 2 (reverse transcription–po

Disorders of Heart Rhythm (Chapter 18)

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A systematic review and meta-analysis of 18 published studies reported short-term and long-term associations of air pollution with atrial fibrillation (AF). For 10-mg/m3 increases in PM2.5 and PM10 concentrations, the OR of AF was 1.01 and 1.03, respectively. The corresponding ORs for long-term exposure were 1.07 for PM2.5 and 1.03 for PM10. SO2 and NO2 were also associated with AF in the short term: ORs for 10-ppb increments were 1.05 and 1.03, respectively.

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A multicenter, open-label, randomized trial evaluated a 2-week continuous electrocardiographic patch and an automated home BP machine with oscillometric AF screening capability for the detection of AF compared with usual care over a 6-month period in participants ≥75 years of age with hypertension. AF detection was 5.3% in the screening group compared with 0.5% in the control group (risk difference, 4.8%; number needed to screen, 21). By 6 months, anticoagulation was more frequently prescribed in the intervention group (4.1% versus 0.9%; risk difference, 3.2%).

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AF has been associated with increased mortality in patients with COVID-19. A meta-analysis of studies published in 2020, including 23 studies and 108 745 patients with COVID-19, showed that AF was associated with increased mortality (pooled effect size, 1.14).

Sudden Cardiac Arrest, Ventricular Arrhythmias, and Inherited Channelopathies (Chapter 19)

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There was a 119% increase in out-of-hospital cardiac arrest during the pandemic compared with earlier control periods in a meta-analysis in 10 countries. For the patients with known outcomes (n=10 992), mortality was 85% compared with 62% for the control periods.

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Coinciding with timing of the pandemic in the United States, CARES Registry (Cardiac Arrest Registry to Enhance Survival) data indicate increased delays to initiation of cardiopulmonary resuscitation for out-of-hospital cardiac arrest and reduced survival after out-of-hospital cardiac arrest. Accompanying these effects were reductions in the frequency of shockable rhythms, out-of-hospital cardiac arrest in public locations, and bystander automated external defibrillator use, whereas field termination of resuscitation efforts increased. There was no significant alteration in frequency of bystander cardiopulmonary resuscitation.

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Survival to hospital discharge was 22.4% of 33 874 adult pulseless in-hospital cardiac arrests at 328 hospitals in Get With The Guidelines 2020 data. Among survivors, 79.5% had good functional status (Cerebral Performance Category 1 or 2) at hospital discharge.

Subclinical Atherosclerosis (Chapter 20)

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In 3116 MESA (Multi-Ethnic Study of Atherosclerosis) participants (58±9 years of age, 63% females) who had no detectable coronary artery calcification (CAC) at baseline and were followed up over 10 years, CAC score >0, CAC score >10, and CAC score >100 were seen in 53%, 36%, and 8% of individuals at 10 years, respectively.

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In a study with 12.3 years of mean follow-up, cancer-related mortality was 1.55-fold higher in individuals who had a CAC score ≥1000 at baseline compared with those who had a CAC score of 0 at baseline, after adjustment for age, sex, and risk factors.

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In 9388 US and Finnish individuals with longitudinal measurement of CVD risk factors and carotid intima-media thickness, CVH declined from childhood to adulthood and was associated with thickening of the intima-media thickness.

Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris (Chapter 21)

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In a European registry of high-volume percutaneous coronary intervention centers, the COVID-19 pandemic was associated with a significant increase in door-to-balloon and total ischemia times. Door-to-balloon time >30 minutes was 57.0% in the period of March to April 2020 compared with 52.9% in March to April 2019 (P=0.003), whereas total ischemia time >12 hours was 11.7% in the 2020 period compared with 9.1% in 2019 (P=0.001).

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In a retrospective cohort study of Medicare fee-for-service patients (N=453 783) who were diagnosed with coronary artery disease, patients that received care at the most socioeconomically deprived practices had higher odds of being admitted for unstable angina (adjusted OR, 1.46) and higher 30-day mortality rates after acute myocardial infarction (adjusted OR, 1.31). After additional adjustment for patient-level area deprivation index, these associations were attenuated (unstable angina adjusted OR, 1.20; 30-day mortality after myocardial infarction adjusted OR, 1.31).

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A pooled analysis of 21 randomized percutaneous coronary intervention trials including 32 877 patients (28% females) found that female sex was an independent risk factor for major adverse cardiovascular events (HR, 1.14) and ischemia-driven target lesion vascularization (HR, 1.23) but not of all-cause or cardiovascular mortality (HR, 0.91 and 0.97, respectively).

Cardiomyopathy and Heart Failure (Chapter 22)

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The lifetime risk of HF remains high, with variation across racial and ethnic groups ranging from 20% to 45% after 45 years of age.

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Secular trends show that the incidence of HF with preserved ejection fraction is increasing and, in contrast, the incidence of HF with reduced ejection fraction is decreasing, whereas both HF subtypes have similar all-cause mortality rates.

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Contemporary HF with reduced ejection fraction guideline-directed medical therapy is estimated to reduce the hazard of cardiovascular death or HF hospitalization by up to 62% compared with limited conventional therapy.

Valvular Diseases (Chapter 23)

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The number of elderly patients with calcific aortic stenosis is projected to more than double by 2050 in both the United States and Europe according to a simulation model in 7 decision analysis studies.

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The pooled prevalence of all aortic stenosis in the elderly is 12.4%, and the prevalence of severe aortic stenosis is 3.4%. The annual volume of transcatheter aortic valve replacement (TAVR) has increased each year since 2011. After the US Food and Drug Administration approval of TAVR for low-risk patients in 2019, the TAVR volume exceeded all forms of surgical aortic valve replacement (n=72 991 versus n=57 626). From 2011 through 2018, extreme- and high-risk patients remained the largest cohort undergoing TAVR, but in 2019, the intermediate-risk cohort was the largest, and low-risk patients with a median 75 years of age increased to 8395, making up 11.5% of all patients undergoing TAVR.

Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism), Chronic Venous Insufficiency, Pulmonary Hypertension (Chapter 24)

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In 2018, there were an estimated ≈1 015 000 total venous thromboembolism cases in the United States.

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In addition, 2019 data show that 37 571 deaths (any mention) resulted from pulmonary embolism and 27 574 deaths (any mention) resulted from pulmonary hypertension.

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In the COVID-19 scenario, the incidence of venous thromboembolism was up to 31% in hospitalized patients. Among them, those who were admitted to the intensive care unit had a 2- to 3-fold greater risk of developing deep vein thrombosis or pulmonary embolism.

Peripheral Artery Disease and Aortic Diseases (Chapter 25)

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From 2011 to 2019, the global prevalence of peripheral artery disease was 5.56% with a higher prevalence in high- compared with low- to middle-income countries (7.37% versus 5.09%, respectively). In 2015, it was estimated that 236.62 million people ≥25 years of age were living with peripheral artery disease.

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In an analysis of 393 017 patients who underwent lower extremity arterial revascularization, 50 750 (12.9%) had at least 1 subsequent hospitalization for major adverse limb events.

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In a population-based screening study of 14 989 participants 60 to 74 years of age, male sex (OR, 1.9), hypertension (OR, 1.8), and family history (OR, 1.6) were associated with a heightened risk of ascending thoracic aortic aneurysm. Diabetes was associated with a lower risk (OR, 0.8).

Quality of Care (Chapter 26)

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Compared with 2019, a lower proportion of cases received bystander cardiopulmonary resuscitation in 2020, and use of automated external defibrillators was lower. There were also longer emergency medical services response times and lower survival to hospital discharge. Those are likely related to the COVID-19 pandemic.

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In a Get With The Guidelines–HF study, inclusion in Medicare Advantage led to a higher proportion of discharge to home with no difference in mortality compared with fee-for-service programs.

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In data from the PINNACLE Registry (Practice Innovation and Clinical Excellence), only about two-thirds of the individuals were treated with appropriate statin therapy as recommended in the American College of Cardiology/AHA guidelines. In addition, higher income was associated with higher likelihood of appropriate statin therapy.

Medical Procedures (Chapter 27)

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As per the Society of Thoracic Surgeons/American College of Cardiology transcatheter valve therapy registry data, TAVR volumes continue to grow, with 13 723 TAVR procedures in 2011 to 2013 and 72 991 TAVR procedures in 2019. In 2019, 669 sites were performing TAVR. In 2019, TAVR volumes (n=72 991) exceeded the volumes for all forms of surgical aortic valve replacement (n=57 626).

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In 2020, 3658 heart transplantations were performed in the United States, the most ever. The highest number of heart transplantations were performed in the states of California (496), Texas (302), Florida (288), and New York (250).

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A global survey of 909 inpatient and outpatient centers performing cardiovascular diagnostic procedures in 108 countries compared procedural volumes for common cardiovascular diagnostic procedures between March 2019 and March 2020/April 2020. This survey indicated that cardiovascular diagnostic procedures decreased by 64% from March 2019 to April 2020.

Economic Cost of Cardiovascular Disease (Chapter 28)

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The average annual direct and indirect cost of CVD in the United States was an estimated $378.0 billion in 2017 to 2018.

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The estimated direct costs of CVD in the United States increased from $103.5 billion in 1996 to 1997 to $226.2 billion in 2017 to 2018.

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By event type, hospital inpatient stays accounted for the highest direct cost ($99.6 billion) in 2017 to 2018 in the United States.

Conclusions

The AHA, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the Statistical Update. The 2022 Statistical Update is the product of a full year’s worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members, without whom publication of this valuable resource would be impossible. Their contributions are gratefully acknowledged.

lymerase chain reaction, serology, or antigen test); and 60% of reported patients were male.