- Heart-related deaths in Massachusetts jumped 16% above normal levels in 2020 and remained elevated through 2023, with some rates still high in 2024
- More people died from heart problems at home rather than in hospitals, suggesting many avoided or couldn’t access medical care during emergencies
- The pandemic fundamentally changed how Americans seek cardiac care, creating lasting health impacts that extend far beyond the initial COVID-19 crisis
BOSTON — Four years after the pandemic began, a disturbing pattern has emerged that goes far beyond COVID-19 itself: Americans are dying from heart problems at dramatically higher rates than before 2020, and the trend shows little sign of stopping.
New research out of Harvard Medical School shows that cardiac deaths in Massachusetts jumped 16% above expected levels in 2020 and remained elevated through 2023 — long after the initial COVID waves subsided. In particular, deaths at home increased significantly, and hospital deaths remained elevated as well. This suggests many people either couldn’t access care or avoided it entirely.
The alarming findings, published in JAMA Network Open, go against the assumption that pandemic-related health impacts were temporary disruptions. Instead, they point to a fundamental shift in how and where Americans are experiencing cardiac emergencies, with potentially deadly consequences that continue years later.
A Deadly Pattern That Won’t Go Away
Between January 2014 and July 2024, researchers analyzed death certificates for more than 127,000 people in Massachusetts who died from heart-related causes. They found a clear break from historical patterns starting in March 2020 — one that has yet to fully resolve.
Before the pandemic, cardiac death rates followed predictable seasonal rhythms, typically peaking during the winter months. But starting in 2020, those patterns became more extreme, with sharper spikes during traditional peak periods and elevated rates persisting throughout the year.
As of mid-2024, some monthly death rates remained higher than expected based on pre-pandemic models.
The Location of Death Reveals the Real Problem
Deaths at home saw some of the most dramatic increases, particularly between 2020 and 2022. Hospital deaths also rose and remained elevated through 2023. This shift suggests that beyond any direct effects of COVID-19 on the heart, the pandemic altered how people sought and received emergency cardiac care.
During the pandemic, many people delayed or avoided medical care altogether due to overwhelmed hospitals, fear of infection, or disruptions to daily routines. Someone experiencing chest pain in 2019 might have gone straight to the emergency room. But during the pandemic, that same person might have stayed home instead.
Dr. Jason Wasfy, a cardiologist at Massachusetts General Hospital who led the study, and his colleagues couldn’t determine from death certificate data exactly why cardiac deaths increased. But the pattern, they wrote, is consistent with pandemic-related disruptions in healthcare delivery and shifts in care-seeking behavior.
Deaths at home are especially concerning because they likely represent missed opportunities for life-saving intervention. Treatments like clot-busting medications, artery-opening procedures, or defibrillators are time-sensitive and depend on hospital access.
“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,” Wasfy says in a statement. “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.”
The Numbers Paint a Grim Picture
Researchers used statistical models to predict what monthly cardiac death rates should have looked like based on data from 2014 to 2019. They accounted for age, sex, seasonal variation, and population changes.
Actual deaths sharply diverged from those projections. Cardiac deaths were 16% higher than expected in 2020, 17% higher in both 2021 and 2022, and 6% higher in 2023. Even in 2024, some months remained above predicted levels.
The study included 127,746 people, with an average age of 77. Women made up 47.9% of the group. Each excess death represents a deviation from historical norms — and many may reflect situations where timely medical care could have made a difference.
Multiple factors likely played a role. During peak pandemic surges, hospitals postponed elective cardiac procedures and faced capacity constraints. Emergency departments reported fewer visits for heart attacks and strokes — not because these events became less common, but because people were less likely to seek care.
Massachusetts Findings Reflect a Broader Problem
The trends seen in Massachusetts echo those reported in other countries. For example, the UK saw a surge in cardiac deaths at home during 2020. But what’s striking in this new analysis is the persistence of elevated death rates into 2023 and 2024 — long after the acute phase of the pandemic.
Massachusetts is known for its strong healthcare infrastructure and high vaccination rates. If cardiac mortality rose this sharply in a well-resourced state, the impact in areas with fewer healthcare resources could be even more severe.
Recovery will require more than just returning to pre-pandemic healthcare models. It will involve understanding why people changed their behavior, what barriers kept them from seeking care, and how to address those gaps before another crisis hits.
As the researchers warned, “we should not base estimates of epidemiological trends on acute hospital data alone, since access problems or other issues may shift those events to homes.” In other words, a drop in hospitalizations doesn’t necessarily mean fewer cardiac events are occurring — just that they may be happening elsewhere.
The Massachusetts data offers an important reminder that the ripple effects of the pandemic are still unfolding. Four years later, Americans are still dying from heart problems at rates that would have been considered alarming before 2020 — often in settings where help is least likely to arrive in time.