Heart attack rates in the US continue to decline, study shows (Image credit: MStudioImages Getty Images)
The COVID-19 pandemic has led to a 35% drop in hospitalizations for heart attacks in the U.S. — but even now, the rate continues to decline. Why is that?
New research suggests that while people forgoing medical care during the pandemic contributed to a short-term decline in cases, a more important reason for the trend is improved heart attack prevention.
A heart attack, or acute myocardial infarction (AMI), occurs when blood flow to the heart is blocked, causing part of the heart muscle to die. The symptoms – including chest, arm or shoulder pain, shortness of breath, fatigue and nausea – are well known, and most people are aware that heart attacks require immediate medical attention in a hospital.
However, the pandemic has been associated with an unusual decline in hospitalizations for acute myocardial infarction.
Since 2020, researchers have been analyzing the reasons for this decline. For example, were patients with heart attack symptoms avoiding seeking medical care? Or were patients who would normally survive a heart attack dying from COVID-19 in the first place?
To explore these questions, the researchers analyzed 7.5 years of Medicare claims data collected from January 2016 to June 2023. They examined the rates of emergency department visits and hospitalizations related to acute myocardial infarction, as well as the characteristics of the patients affected.
A study published July 31 in JAMA Cardiology found that AMI visits and hospitalizations were lowest during the peak of the pandemic, as measured by COVID-19 deaths. The same was true for other urgent or painful conditions, such as kidney stones. This suggests that people who might normally seek care chose to stay home when their risk of contracting COVID-19 was high.
The researchers tried to account for factors such as excess COVID-19 deaths, which are those that exceed the number of deaths expected under normal circumstances. However, this adjustment did not explain the decline in hospital visits, so the researchers concluded that avoidance of medical care was the main reason for the pandemic-related decline.
“While there have been more deaths overall during the pandemic, we must recognize that only some of these patients may have developed acute myocardial infarction during the same time period,” said study first author Andrew Wilcock, an assistant professor at the University of Vermont Larner College of Medicine and a visiting scholar at Harvard Medical School.
The impact of excess mortality or changes in Medicare enrollment was “so small for the expected [MI] rates that it could not explain the deficits we observed,” Wilcock told Live Science in an email.
However, even after pandemic restrictions were lifted, the number of visits and hospitalizations for MI remained lower than before the pandemic, reflecting a broader and sustained decline in heart attack rates. The researchers suggest a combination of reasons for this trend, including fewer smokers, healthier diets, and better treatment for underlying conditions such as high cholesterol and high blood pressure.
“It’s not just one factor, but a combination of different causes,” Wilcock said. “Lifestyle changes and better medications are compelling explanations for the downward trend in AMI hospitalizations.”
However, there is still much work ahead.
“We've made progress, but we still have a lot to do in terms of smoking cessation, physical activity, proper diet, blood pressure and cholesterol control, etc.,” said Dr. Robert Bonow, a professor of cardiology at Northwestern University who was not involved in the study. “Cardiovascular disease continues to be the leading cause of death worldwide. It would be nice if they could empty
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