US Cardiovascular Deaths During the COVID-19 Pandemic

Quick Takes

  • In the early phase of the COVID-19 pandemic in the United States, a nationwide increase in deaths due to ischemic heart disease and hypertensive diseases was observed.
  • Among US jurisdictions with early COVID-19 surges, New York City exhibited the largest increase in ischemic heart disease deaths, and only New Jersey had an increase in cerebrovascular disease deaths.

Study Questions:

How were population-level cardiovascular deaths in the United States affected by the coronavirus disease 2019 (COVID-19) pandemic?

Methods:

This was an observational cohort study based on data from the National Center for Health Statistics. Weekly death data were obtained for January-June 2020; the pre-pandemic period was defined as January 1-March 17, and the pandemic period was March 18-June 2, 2000. Data from 2019 served as a historical control. New York City and states with early COVID-19 surges (New York, New Jersey, Illinois, Massachusetts, Louisiana, and Michigan) were subjects of a focused analysis.

Results:

A total of 397,042 cardiovascular deaths occurred from January-June 2, 2020 in the United States. During the pandemic period, a nationwide increase in deaths due to ischemic heart disease (ratio of the relative change in deaths per 100,000 in 2020 vs. 2019: 1.11; 95% confidence interval [CI], 1.04-1.18) and hypertensive diseases (1.17; 95% CI, 1.09-1.26) was observed. No significant change occurred nationwide for deaths due to heart failure, cerebrovascular disease, or other circulatory disorders. New York City had the largest increase in deaths due to ischemic heart disease (ratio, 2.39; 95% CI, 1.39-4.09), while more modest increases were seen in the remainder of New York State, New Jersey, Michigan, and Illinois, but not in Massachusetts or Louisiana. New Jersey was the only jurisdiction that exhibited an increase in deaths due to cerebrovascular disease (ratio, 1.28; 95% CI, 1.09-1.51). Deaths due to heart failure did not increase in any state.

Conclusions:

Increased deaths due to ischemic heart disease and hypertensive diseases occurred during the early portion of the COVID-19 pandemic in the United States, while deaths due to heart failure were unaffected. Among jurisdictions with early COVID-19 surges, New York City exhibited the largest increase in ischemic heart disease deaths, and only New Jersey had an increase in cerebrovascular disease deaths.

Perspective:

Previous studies have shown decreases in hospital admissions for acute coronary syndromes and interventions for ST-segment elevation myocardial infarction during the initial phase of the pandemic. The present findings support the idea that many patients suffered cardiovascular events without seeking medical attention, or presented in a delayed fashion and suffered worse clinical outcomes, as many practitioners feared. Some of the excess cardiovascular deaths may have been a consequence of COVID-19, given the thrombophilia associated with the viral syndrome. It is encouraging that heart failure deaths did not seem to increase during the early pandemic, but providers should always encourage chronically ill patients to seek early medical attention for changes in symptomatology.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Hypertension, Chronic Angina

Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Cerebrovascular Disorders, Chronic Disease, Coronavirus, COVID-19, Heart Failure, Hypertension, Myocardial Ischemia, Primary Prevention, ST Elevation Myocardial Infarction, Thrombophilia


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