Higher-Than-Usual Number of Cardiovascular Deaths Part of COVID's Larger Picture

 

• The number of cardiac deaths exceeded expectations during the years of the COVID pandemic, according to data from a single state.
• A sharp increase was reported for deaths at home in particular.
• The observed excess mortality is thought to be related to the lower cardiovascular procedural volumes previously reported.

Cardiovascular mortality has been higher than usual since the COVID-19 pandemic, data from Massachusetts suggested.

Records from the state showed that the observed number of cardiac deaths in 2020 was 16% higher than expected, 17% higher than expected in 2021 and 2022, and 6% higher than expected in 2023, reported Jason Wasfy, MD, MPhil, of Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues.

"In this population-based cohort study of Massachusetts decedents, we found cardiac deaths increased substantially starting in 2020, with exaggerated seasonal patterns and increases in deaths at home," the authors wrote in JAMA Network Openopens in a new tab or window. "The U.S. increase has persisted well past the early pandemic; as of mid-2024, some monthly rates remain elevated."

Wasfy and colleagues cited the changes in where and when deaths take place to reconcile their findings with other studies showing reduced admissions for cardiac emergencies in various countries in the aftermath of COVID-19.

Notably, a report from March 2020 -- arguably the first month of the pandemic in the U.S. -- had shown major disruptions to cardiovascular care, with cath lab activations for ST-segment elevation myocardial infarction down around 40%opens in a new tab or window in high-volume centers.

American cardiac surgeons also reported a steep drop in adult cardiac surgery volumesopens in a new tab or window starting in April 2020.

The present study suggests that these changes did not reflect real shifts in cardiac event rates, but rather the use of healthcare that can be captured by acute hospital data.

"Lots of reports have shown that there have been fewer heart attacks in hospitals since 2020 -- but something seems to be missing from that data. We now show that if you account for deaths at home, cardiac deaths are going up and have stayed up for years," said Wasfy in a press release.

While the study was unable to explain the excess cardiac deaths, the authors suggested hospital and outpatient facility limitations and hospital avoidance as potential causes.

This would tie the problem to people with heart disease not getting adequate careopens in a new tab or window -- whether for patient fear of contracting SARS-CoV-2, hospital staffing difficulties, bed capacity constraints, or other reasons -- as an indirect result of the pandemicopens in a new tab or window.

It was beyond the scope of this study to probe potential contributions from long COVIDopens in a new tab or window and myocarditisopens in a new tab or window, a side effect from the mRNA vaccines.

Of note, 2021 was the year that COVID-19 vaccines were made available to most Americans. Thereafter came a period of recoveryopens in a new tab or window across cardiac services, before the huge spike in cases from the Omicron variant threw another wrench in the system starting at the end of that year.

For the present study, Wasfy and colleagues used Massachusetts state death certificate records from January 2014 to July 2024. U.S. Census data were used to estimate age- and sex-adjusted expected monthly cardiac death rates. They included 127,746 people (mean age 77 years, 47.9% women).

Wasfy's group reported that from 2020 to 2022, cardiac mortality rates were higher than expected for deaths at home; deaths in hospitals were more than expected from 2020 to 2023.

The nature of the death records used left room for possible misclassification of cause of death, the investigators acknowledged.

"Further work is needed to improve the resilience of cardiac care during future pandemics," Wasfy and colleagues wrote.

Disclosures

The study was supported by an NIH grant.

Wasfy had no disclosures. A co-author reported receiving consulting fees from Cambridge Health Alliance, Brandeis University, and Alta Med, and giving keynote speeches for Invitx and the University of South Carolina.

Primary Source

JAMA Network Open

Source Reference: opens in a new tab or windowWasfy JH, et al "Postpandemic cardiac mortality rates" JAMA Netw Open 2025; DOI: 10.1001/jamanetworkopen.2025.12919.

https://www.medpagetoday.com/cardiology/prevention/115828