Independent of COVID, US Cardiovascular Deaths Increase

As the number of COVID-19 infections continues to rise nationwide, more than 360,000 Americans have already died from the potentially deadly viral infection. But recent reports describe an increase in mortality during the pandemic that cannot be explained by COVID-19 deaths alone.

In a study from the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center (BIDMC), researchers analyzed data from the National Center for Health Statistics to compare the rate of cardiovascular-related deaths before and after the onset of the pandemic in the United States, relative to the same periods in the prior year. The observational study, published in the Journal of the American College of Cardiology, found that cardiovascular deaths unrelated to COVID-19 increased during the pandemic.

“Hospital visits for heart attacks and other cardiac conditions declined markedly during the pandemic, fueling physicians’ concerns that people with acute conditions may be staying at home due to fear of exposure to COVID-19,” said the study’s corresponding author, Rishi K. Wadhera, MD, MPP, MPhil, a cardiologist and researcher at the Smith Center and BIDMC. “Our research raises concern that the avoidance of hospitals, deferral of semi-elective procedures and care, and substantial strain imposed on hospitals during the early phase of the pandemic may have had an indirect toll on patients with cardiovascular disease.”

Wadhera and colleagues evaluated the rate of US deaths due to cardiovascular causes after the onset of the COVID-19 pandemic (mid-March to June 2020) relative to the immediately preceding 11 weeks prepandemic. The team also compared these two periods of 2020 with the same weeks in 2019.

The team found a significant rise in cardiac deaths after the onset of the pandemic in the United States. Deaths due to ischemic heart diseases (related to narrowing of the arteries) and hypertensive (related to high blood pressure) diseases increased by 11% and 17%, respectively, compared with the previous year. The rise in deaths was concentrated in areas most affected by COVID-19 this spring. New York State, New Jersey, Michigan, and Illinois experienced increases in cardiac deaths, with New York City seeing the largest relative rise in deaths (139%) due to ischemic heart diseases. Massachusetts—an epicenter for COVID-19 during the spring—didn’t see similar increases in cardiac deaths during this time period.

“These data are particularly relevant today, as we find ourselves in the midst of a surge in COVID-19 cases that looks to be exceeding what we experienced last spring,” says senior author Robert Yeh, MD, MBA, director of the Smith Center for Outcomes Research at BIDMC. “Ensuring that patients with cardiovascular disease continue to receive necessary care during our public health response to the pandemic will be of paramount importance.”

Wadhera, Yeh, and colleagues suggest that the strain imposed by COVID-19 on some hospitals may have also led to delays in care for hospitalized patients without COVID-19. The pandemic-related deferral of semielective procedures, as well as delays in emergency service response times, have also likely contributed to the increase in deaths. The authors also suggest that a proportion of deaths may have been due to the cardiovascular complications of undiagnosed COVID-19.

“Overall, our data highlight the urgent need to improve public health messaging and rapidly expand health care system resources to ensure that patients with emergent conditions seek and receive medical care—particularly in regions currently experiencing a sharp rise in COVID-19 cases,” Wadhera says.

— Source: Beth Israel Deaconess Medical Center