Postpandemic Cardiac Mortality Rates

"Introduction

Studies using hospital data from 15 countries report a remarkably consistent 20% to 34% reduction in acute myocardial infarction (AMI) hospitalizations after the start of the COVID-19 pandemic. Cardiac procedures also decreased, while inpatient ST-segment elevation MI (STEMI) mortality increased in some countries. It is unclear whether these findings reflect actual changes in event rates, changes in hospital use, or limitations in using data restricted to hospitalized inpatients...

Results

Of 127 746 included individuals, mean (SD) age was 77 (14) years and 61 262 were female (47.9%). Figure 1 displays the observed and expected age- and sex-standardized total monthly cardiac mortality rates. Annual observed cardiac mortality exceeded 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. Stratified by location of death, monthly cardiac mortality rates exceeded expected for deaths at home between 2020 and 2022 and for deaths in hospitals between 2020 and 2023 (Figure 2).

Figure 1.  Age- and Sex-Standardized Cardiac Mortality Rates Per 100 000 Massachusetts Residents, January 2014 to July 2024

The solid orange line indicates the observed monthly age- and sex-standardized cardiac mortality rate, and the blue dashed line represents expected monthly age- and sex-standardized cardiac mortality rate. The blue shaded area (2020 to 2024) indicates the bootstrapped 95% CI for the expected rates.

Figure 2.  Observed and Expected Age- and Sex-Standardized Cardiac Mortality Rates Per 100 000 Massachusetts Residents, Stratified by Location of Death, January 2014 to July 2024

The solid orange line indicates the observed monthly age- and sex-standardized cardiac mortality rate for a given location, and the blue dashed line indicates the expected monthly age- and sex-standardized cardiac mortality rate for a given location. The blue shaded area (2020 to 2024) indicates the bootstrapped 95% CI for the expected rates."