Cardiac Deaths Rose Sharply at Home Post-COVID-19, Study Finds

Cardiac deaths have surged since the COVID-19 pandemic began in 2020, with sharper seasonal spikes and more deaths occurring at home, a new study finds.1

A team of investigators from Mass General Brigham analyzed death certificate data from nearly 128,000 individuals who died in Massachusetts, finding that cardiac deaths exceeded expected levels between 2020 and 2023.

“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,” said Jason H. Wasfy, MD, MPhil, director of outcomes research at the division of cardiology at Massachusetts General Hospital.2 “We now show that if you account for deaths at home, cardiac deaths are going up and have stayed up for years. Today, there are a lot more people having cardiac deaths at home, which also raises the concern that people with heart disease haven’t been getting the care they need since the pandemic.”

Hospital data from 15 countries have shown a consistent 20–34% reduction in acute myocardial infarction (AMI) hospitalizations since the start of the COVID-19 pandemic.3 At the same time, cardiac procedures decreased, while inpatient ST-segment elevation MI (STEMI) mortality rates increased, suggesting uncertainties in whether these data reflect actual changes in event rates or hospital use.

For this study, Wasfy and colleagues evaluated monthly and annual population-based cardiac mortality rates against the expected monthly cardiac deaths during and after the COVID-19 pandemic. Death certificate data, stratified by location in Massachusetts, were examined over the observation period.1

Total, age-specific, and sex-specific mid-year population estimates in Massachusetts were collected from 2014 to 2023 in the US Census. Age and sex distributions were used to standardize the population estimates within the 2014 Massachusetts population.

Wasfy and colleagues fitted negative binomial regression models with data from 2014 to 2019, including age group, sex, month, year, and log of population size. The team presented the observed and expected age- and sex-standardized monthly cardiac deaths per 100,000 residents.

Among 127,746 individuals, the mean age was 77 years, and 61,262 (47.9%) were female. Analyses showed the annual observed cardiac mortality rates were higher than expected from 2020 to 2023: 16% (95% CI, 13–19) higher in 2020, 17% (95% CI, 14–21) higher in 2021, 17% (95% CI, 13–21) higher in 2022, and 6% (95% CI, 2–11) higher in 2023.

By location of death, Wasfy and colleagues found the monthly cardiac mortality rates exceeded those expected for deaths at home between 2020 and 2022, and for deaths in hospitals between 2020 and 2023. The team called for further analysis to improve the resilience of cardiac care during future pandemics and a shift away from estimates of epidemiological trends on acute hospital data alone.1

“Healthcare systems around the world have experienced multiple shocks since 2020. Our findings suggest that both patient choices about seeking care and outcomes after experiencing a cardiac emergency also have changed,” said Jason Hsu, MD, MBA, a faculty member and director of the program for clinical economics and policy analysis at the Mongan Institute at Massachusetts General Hospital.2 “Had we not examined mortality using death certificate data, the increases in population cardiac mortality could have gone unnoticed.”

References

1. Wasfy JD, Lin Y, Price M, et al. Postpandemic Cardiac Mortality Rates. JAMA Network Open. Published online May 30, 2025. doi:10.1001/jamanetworkopen.2025.12919.

2. Mass General Brigham. At-home heart attacks and cardiac deaths on the rise since COVID-19 pandemic. EurekAlert. Published May 30, 2025. Accessed May 30, 2025. https://www.eurekalert.org/news-releases/1085499.

3. Sofi F, Dinu M, Reboldi G, et al. Worldwide impact of COVID-19 on hospital admissions for non-ST-elevation acute coronary syndromes (NSTACS): a systematic review with meta-analysis of 553 038 cases. Eur Heart J Qual Care Clin Outcomes. 2024;10(3):265-283. doi:10.1093/ehjqcco/qcad048.