This study examines geographic patterns of heart disease death rates and recent changes in death rates for adults aged 35-64 years by level of deprivation as measured by the Multidimensional Deprivation Index (MDI). County-level heart disease death rates (2019) and percent change in heart disease death rates (2010-2019) were calculated using a Bayesian conditional autoregressive model for ages 35-64 years. County-level MDI values were calculated by the US Census Bureau based upon six dimensions of deprivation. MDI values were categorized relative to the national MDI. The distributions of heart disease death rates and trends were examined across MDI categories. County-level patterns of high MDI values overlapped extensively with high heart disease death rates, with 48.4% of counties with the highest rates having the highest MDI levels. Likewise, the proportion of counties with the highest MDI levels increased with greater county-level percent increases in heart disease death rates: from 10.2% in counties with strong decreases in death rates to 20.5% in counties with strong increases in death rates. The observed patterns corroborate the results from previous studies demonstrating higher mortality rates among populations with more adverse socioeconomic conditions and suggest greater increases in heart disease death rates in counties with higher deprivation.