Heart Disease Deaths Spiked During COVID After 10-Year Decline

Marlene Busko

November 25, 2022

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Yearly deaths from heart disease in the United States increased in 2020 during the COVID pandemic, after a steady decline during the previous decade, a new study shows.

The rate of death from heart disease in the overall population rebounded in 2020 to what it had been in 2015 — essentially wiping out 5 years of progress, researchers report. 

The uptick in death rates was even greater in non-Hispanic Black patients and in younger adults aged 35 to 74 years — a loss of 10 years of progress.

Rebecca C. Woodruff, PhD, MPH, presented these findings at the American Heart Association (AHA) 2022 Scientific Sessions.

As a result of better detection and treatment of cardiovascular risk factors, the rate of death from cardiac disease has been declining for decades in the United States, and the decline from 1900 to 1999 "has been recognized as a top public health achievement of the 20th century," Woodruff, an epidemiologist at the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), told theheart.org | Medscape Cardiology.

The reversal of this trend during the first year of the pandemic is likely due to many factors, she said. The pandemic disrupted access to healthcare for many people, for example, which may have resulted in delays in detecting and treating heart disease. The pandemic "may have made it harder for people to do the things we know prevent heart disease," she noted.

Further, emerging evidence suggests that people who have had COVID-19 are at increased risk for new or worsening cardiovascular disease.

Non-Hispanic Black patients and younger adults may have had more exposure to COVID-19 at their workplace, less financial stability, greater stress, and more limited access to healthcare.

The study findings "underscore the importance of continued detection and treatment of both acute and chronic heart disease," Woodruff said, and of "counseling patients on the importance of improving their cardiovascular health by following the American Heart Association's Life's Essential 8 — eating better, being more active, quitting tobacco, getting healthy sleep, managing weight, controlling cholesterol, managing blood sugar, and managing blood pressure."

"COVID-19 vaccines can help everyone, especially those with underlying heart disease or other health conditions, protect themselves from severe COVID-19," she added. And "prioritizing equitable access to high-quality healthcare can help adults prevent and manage heart disease, reduce disparities in heart disease mortality, and improve outcomes."

"Landmark Study" a Wake-Up Call

"Virtually all clinicians are well aware of the remarkable, continuous declines in mortality from heart disease in the US population that have occurred over the past few decades," Andrew J. Einstein, MD, PhD, who was not involved with this research, commented to theheart.org | Medscape Cardiology.

"This landmark epidemiologic study...has identified two very disturbing changes to this downward trend which should concern all clinicians," said Einstein, who is professor of medicine and director of nuclear cardiology, cardiac CT, and cardiac MRI, at Columbia University Irving Medical Center in New York City.

First, there was a sharp increase in the heart disease death rate in adults in 2020, the first year of the pandemic, affecting all segments of the US population. Second, there were striking disparities between demographic groups, and this reversal in progress especially affected Black adults and younger adults.

The findings emphasize "the importance of redoubling efforts to ensure that all adults, but especially Black people and younger people, are plugged into the healthcare system and receive quality care to ensure that optimal attention is being paid to disease prevention, heart-healthy living, risk factor management, timely diagnosis and treatment, and make up for care missed during the first year of the pandemic," said Einstein.

"Clearly the findings of this important study should serve as a wake-up call," he said, "since we slid back many years of progress."  

Clinicians should reach out to renew the provider–patient bond with patients lost to them during the pandemic and ensure for all patients that gaps in care that have developed are closed in a timely fashion, he continued. "This is especially critical for our Black and younger patients."  

"Let's hope that 2020 was an aberration, and the introduction of COVID vaccination, advances in COVID treatment, the evolution of the virus into less fatal strains, and the opening up of society again in 2021 and beyond all lead to a strong rebound in patient engagement with and measures of cardiovascular health," he said.   

"But we need to obtain and evaluate the relevant data, across all aspects of heart care, while not dallying in actively instituting programs to engage patients and populations in efforts promoting heart health."

National Study

For this analysis, the researchers obtained age-adjusted annual rates of death from heart disease from 2010 to 2020 from the CDC's WONDER database.

They identified adults aged 35 years and older with heart disease as cause of death, based on International Classification of Diseases, 10th revision codes.

They found that:

  • The age-adjusted rate of heart disease deaths per 100,000 adults declined each year from 2010 to 2019 and increased in 2020 — overall, and in men, in women, in all age groups (35 to 54, 55 to 74, and 75+), and among all race and Hispanic ethnicity groups.

  • Overall, heart disease deaths dropped 9.8% (from 347.3 to 313.0 per 100,000 adults) from 2010 to 2019, but they increased by 4.1% (to 325.9 per 100,000 adults) in 2020, which was about the same as this rate was in 2015 (325.6 per 100,000 adults).

  • Among non-Hispanic Blacks, heart disease deaths declined by 10.4% from 2010 to 2019, but they increased by 11.2% to 440.7 per 100,000 in 2020, which was about the same rate as in 2010 (442.4 per 100,000).

  • Among adults aged 35 to 54, heart disease deaths declined by 5.5% from 2010 to 2019 and increased by 12.0% in 2020, which was higher than the rate it was in 2010 (54.1 vs 51.1 per 100,000).

  • Among adults aged 55 to 74, heart disease deaths declined by 2.3% from 2010 to 2019 and increased by 7.8% in 2020, which was higher than the rate it was in 2010 (297.3 vs 282.5 per 100,000).

  • In 2020, approximately 7 years of progress in declining heart death rates was lost among men and 3 years of progress was lost among women.

The authors and Einstein have no relevant financial disclosures.

American Heart Association (AHA) 2022 Scientific Sessions. Abstract VP161.  

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