Pandemic appears to have accelerated a long-brewing reversal in US heart failure deaths

Unlike heart attacks or strokes, which are sudden events, heart failure reflects cumulative damage and is especially sensitive to gaps in routine care and long-term management - disrupted during the pandemic. Photo / 123rf.com

The Covid pandemic didn’t just kill people directly.

It appears to have accelerated a long-brewing reversal in United States heart failure deaths with mortality climbing faster since 2020 after years of decline, new research shows.

The increases have been most pronounced among younger adults and black Americans, pointing to disruptions in care and worsening conditions such as diabetes, obesity and high blood pressure that intensified during the health emergency, according to a study published today in the Journal of the American College of Cardiology.

Heart failure has emerged as one of the clearest signals of the pandemic’s lasting impact on chronic disease.

Unlike heart attacks or strokes, which are sudden events, heart failure reflects cumulative damage and is especially sensitive to gaps in routine care and long-term management.

The pattern reflects a convergence of forces rather than a single cause, said co-author Harlan Krumholz, a Yale University cardiologist and the journal’s editor-in-chief.

Rising cardiometabolic risk factors have been appearing earlier in life for years and didn’t pause during the pandemic, while disruptions in care, delayed diagnoses, and fragmented follow-up left some patients more exposed, he said.

“What we are seeing reflects a mix of worsening cardiometabolic risk, structural and health system failures, and the lingering effects of pandemic-era disruption, rather than a new biology per se,” Krumholz said in an email.

Nationally, age-adjusted heart failure death rates declined from 1999 through to about 2011 before reversing course.

The rise accelerated during the early Covid period and has persisted, with particularly steep increases among adults aged under-65, men, black people, rural populations, and residents of the South and Midwest US, the report found.

Heart failure was listed as the underlying cause of more than 92,000 US deaths in 2024 and as a contributing cause in over 423,000 others, according to the National Centre for Health Statistics.

Mortality rates were highest among older adults, but the sharpest increases occurred in younger and middle-aged groups - an unusual shift that has unsettled cardiologists.

The findings add to evidence that the pandemic’s cardiovascular toll didn’t end when hospitals reopened or vaccines arrived.

If heart failure mortality continues to rise, it risks becoming a dominant driver of post-pandemic heart disease deaths, threatening to reverse decades of progress - especially for populations already bearing the highest burden of chronic illness.

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