With new CVD treatments arriving each year, “there’s no reason why outcomes should be getting worse,” says Jason Wasfy.
Cardiac mortality rates have increased in Massachusetts annually since the start of the COVID-19 pandemic in 2020, with exaggerated seasonal patterns and upticks in at-home deaths, according to new population-based data.
The findings stand somewhat in contrast to reports showing a downward trend for cardiac hospitalizations over the same time period but bolster the notion that some patients who need care aren’t being treated properly.
“There’s no reason why outcomes should be getting worse,” lead author Jason H. Wasfy, MD (Massachusetts General Hospital, Boston), told TCTMD. “There are new drugs available every year. There are new procedures available. So, why should outcomes be getting worse? It suggests something wrong with the healthcare system.”
In their study, published last week as a research letter in JAMA Network Open, Wasfy and colleagues looked at Massachusetts death certificate data between January 2014 and July 2024 and compared that to total, age-specific, and sex-specific population estimates to calculate expected and observed monthly cardiac mortality rates.
In total, 127,746 deaths were recorded (mean age 77 years; 47.9% female). From 2020 to 2023, annual observed cardiac mortality was greater than expected: 16% higher in 2020, 17% greater in both 2021 and 2022, and 6% higher in 2023.
By location, monthly at-home cardiac mortality rates were higher than expected between 2020 and 2022. Deaths occurring in the hospital also were more frequent than expected between 2020 and 2023.
It suggests that there’s ongoing dysfunction and distress in the healthcare system. We are not effectively delivering cardiology care to patients at risk. Jason H. Wasfy
While previous research has shown increases in cardiac mortality in the winter months compared with the summer, Wasfy said this pattern was “even worse” during the pandemic. It’s likely these overall findings are representative of greater US patterns, even potentially global ones, he suggested.
“We studied Massachusetts because in Massachusetts there are additional requirements for adjudication of deaths by medical examiner, including deaths at home,” he said. Thanks to that, “we can trust the data more, but we have every reason to think that this is happening in other places as well. There’s nothing different about Massachusetts that we think is unique.”
While it’s likely that many cardiac patients stayed away from hospitals during 2020 and into 2021 to avoid potential infection, it’s less likely that this still happened into 2023 and 2024, Wasfy said. “It suggests that there’s ongoing dysfunction and distress in the healthcare system. We are not effectively delivering cardiology care to patients at risk.”
He said the data should sound an alarm for everyone involved in healthcare delivery. “We need to fundamentally rethink the way cardiology care is delivered to patients at risk. We can continue to develop new drugs and new procedures, and I hope we do because that will improve outcomes. But despite that progress, I think it’s problematic that outcomes continue to worsen. It really points to the lack of knowledge and creativity about the way that cardiology care is delivered.”
Wasfy added that his team plans to continue research in this area, including helping to identify “pain points” in the process that have been causing adverse outcomes.
link