Heart Failure Mortality Rates Surge to Highest Levels in 20 Years
Heart Failure Mortality Rates Surge to Highest Levels in 20 Years

By Megan Redshaw, J.D.

An unprecedented number of people are dying from heart failure, completely reversing long-standing declines in cardiovascular mortality rates observed just two decades ago.

A cohort study published on April 24 in JAMA Cardiology using U.S. death certificate data showed deaths related to heart failure decreased from 1999 to 2012, plateaued, and then steadily rose from 2012 to 2021, with an acceleration observed from 2020 to 2021.

“What the paper shows is that more patients die from heart failure now than 20 years ago. The concerning thing about it is that we made good strides in improving that trend for a decade, and the last decade, that trend reversed,” senior author Dr. Marat Fudim, a heart failure cardiologist at the Duke University Medical Center, told The Epoch Times.

Although the researchers found typical disparities between men and women and among certain racial and ethnic groups, the greatest increase in heart failure-related deaths occurred among individuals younger than 45.

According to the study, between 1999 and 2021, there was a reversal in the death rate of 906 percent among people under 45 years old, 385 percent among people 45 to 64 years old, 84 percent for those 65 and older, and 103 percent overall. The analysis observed similar results when looking at heart failure as the underlying cause of death.

According to the Journal of Cardiac Failure, approximately 6.7 million Americans over age 20 have heart failure, and the prevalence is expected to rise to 8.5 million Americans by 2030.

Heart failure, also known as congestive heart failure, is a severe medical condition that occurs when the heart cannot pump enough blood to meet the body’s needs. This can happen either because the heart can’t fill up with enough blood or it is too weak to pump properly. The condition can come on suddenly or develop over time and can affect the left or right side of the heart.

According to the National Heart, Lung, and Blood Institute, heart failure is most often caused by a medical condition that damages the heart, such as heart disease, inflammation, high blood pressure, cardiomyopathy, or an irregular heartbeat. A person with heart failure may experience feeling tired, have shortness of breath, or notice fluid buildup in the lower body around the stomach, or neck—although these symptoms may not be noticed initially.

Heart failure can also lead to other conditions like pulmonary hypertension, irregular heartbeat, heart valve disease, and sudden cardiac arrest.

The study’s authors noted that the reversal in heart failure-related mortality began long before the COVID-19 pandemic, but the largest jump in mortality was observed in 2020 and 2021, suggesting the pandemic and limited access to healthcare may have accelerated the trend.

Underlying Factors

No one factor can explain the entirety of the trend, as there’s likely a combination of factors contributing to the shift in heart failure incidence to a younger age group and the overall reversal in mortality, Dr. Fudim told The Epoch Times.

Dr. Fudim provided several reasons that may explain higher death rates from heart failure. First, the prevalence of patients with heart failure is on the rise, which subsequently leads to more deaths in patients from and with heart failure. However, heart failure trends have been gradually increasing for decades, so this alone can’t explain the “U-shaped trend we showed,” he said.

Second, the United States isn’t focused on cardiovascular disease prevention. Third, comorbidities such as diabetes, obesity, hypertension, liver disease, and renal disease have been rising for a few decades and are now translating to worse heart failure-related outcomes.

“This hits younger generations specifically. This would make an ‘average’ heart failure patient sicker, so to say,” Dr. Fudim said.

Fourth, it has become harder for people to access health care, medical providers, and needed treatment, especially in the “urban/rural divide,” where the rural mortality rate is significantly higher.

“Last but not least, this trend […] preceded COVID by many years but has not been helped by COVID—and the impact it had on health care, preventive services, worsening socioeconomic divide, etc.,” Dr. Fudim added.

Dr. Andrew Foy, a cardiologist at Penn State, told The Epoch Times in an email that he cannot draw any conclusions about the incidence rates shifting to younger populations since the data deals exclusively with age-adjusted mortality rates.

“We have to seriously consider the impact (or lack thereof) of new therapies and interventions on HF [heart failure] disease management,” Dr. Foy said.

“I know there are people in this field who will cite ‘treatment gaps’ as a potential explanation (this is an area where results from our recent industry payments to physicians paper may be revealing); however, there is no rational reason why treatment gaps would get worse and not better over time,” he added.

Dr. Foy noted some “treatment gaps” could only get better as products were not available before 2012.

“To me, this data highlights the concept of the ‘Efficacy-Effectiveness Gap’ for new therapies and interventions, which are tested in perfect conditions and patients in clinical trials and may not translate to real-world patient populations. I think, at the very least, we must consider this here and contextualize it with the increasing costs of new treatments in HF patients,” he said.

An important limitation noted in the JAMA Cardiology study is the reliance on death certificate data from the Centers for Disease Control and Prevention (CDC), which may mistakenly attribute some deaths to other causes. Additionally, people are surviving longer with conditions that predispose them to heart failure, which can increase the prevalence of the condition and, by extension, the mortality rate.

COVID-19 Vaccine

Although the study analyzed heart failure-related deaths prior to the December 2020 COVID-19 vaccine rollout, data suggests COVID-19 vaccines may have worsened the trend.

“While the pandemic certainly strained healthcare resources, we must consider all factors, including potential direct cardiac damage from COVID-19 and possibly from interventions such as vaccines, which have been associated with myocarditis and pericarditis. These conditions inflame the heart and could lead to heart failure,” physician and research scientist Dr. Houman David Hemmati said in a post on X.

According to U.S. health agencies, both mRNA COVID-19 vaccines by Pfizer and Moderna can increase the risk of myocarditis and pericarditis, especially among young males ages 18 to 39 years. Postmarketing data on COVID-19 vaccines shows an increased risk of heart inflammation, particularly within the first week of vaccination.

Myocarditis is inflammation of the heart muscle that can lead to cardiac arrhythmia, heart failure, and death. It can also cause the heart muscle to weaken or affect the heart’s electrical system, which can lead to cardiomyopathy and irregular heartbeat—two underlying conditions that contribute to heart failure. Research shows pericarditis can also cause heart failure.

In a 2023 retrospective study published in the Journal of Cardiac Failure, four patients aged 22 to 43 years old developed heart failure within three weeks of receiving a second dose of Pfizer’s COVID-19 vaccine. None of the patients had a prior cardiac history or predisposing conditions.

In a recently published systematic review in ESC Heart Failure, researchers investigated potential causal links between COVID-19 vaccines and death from myocarditis using post-mortem analysis. They identified 28 deaths that were most likely causally linked to COVID-19 vaccination. In 26 cases, the cardiovascular system was the only organ system affected, and the mean age of death was 44.4 years. In several cases, post-mortem findings showed severe arrhythmias, progressive heart failure, or cardiomyopathy.

According to data from the CDC’s Vaccine Adverse Event Reporting System (VAERS), 37,382 deaths following COVID-19 vaccination were reported between Dec. 14, 2020, and March 29. Of those deaths, data show at least 15 percent were related to cardiac disorders. Additionally, 5,900 cases of heart failure and 26,944 cases of myocarditis and pericarditis have been reported following COVID-19 vaccination. Since updates to filed VAERS reports are not made publically available, it is unknown how many reported cardiovascular conditions resulted in heart failure.

VAERS is a voluntary reporting system, comanaged by the U.S. Food and Drug Administration and CDC, designed to detect vaccine safety signals, but it is estimated to represent less than 1 percent of actual adverse events. Although VAERS is not designed to determine if a vaccine caused a certain health problem, it is useful for detecting “unusual or unexpected patterns” following vaccination that might indicate a possible safety issue.

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