At-Home Heart Attacks and Cardiac Deaths on the Rise Since COVID-19 Pandemic

Heart attacks are the leading cause of death globally, yet some statistics from many different countries suggest these events declined in frequency since the COVID-19 pandemic. Mass General Brigham researchers evaluated whether these cardiac trends reflect a true change in event rates, or if they reflect that more people are dying at home rather than in hospitals. Their findings highlight potential shortcomings of cardiac care during and in the years following the height of the pandemic, suggesting opportunities to better treat and prevent cardiac events in people at risk. The study published today in JAMA Network Open.

“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,” said corresponding author Jason H. Wasfy, MD, MPhil,  director of Outcomes Research at the Massachusetts General Hospital Cardiology Division and a faculty member at the Mongan Institute at Massachusetts General Hospital, a founding member of the Mass General Brigham healthcare system. “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 researchers looked at death certificate data from 127,746 people who died in Massachusetts and found cardiac deaths exceeded anticipated levels between 2020 and 2023. Using data from 2014 to 2019, the team set an expected cardiac death rate to compare the new 2020 to 2023 rate against. Cardiac deaths were 16% higher than expected in 2020, 17% higher in 2021 and 2022, and 6% higher in 2023. Notably, this significant increase in cardiac deaths happened despite lower cardiac-related hospital admissions, meaning more deaths occurred at home.

“Healthcare systems around the world have experienced multiple shocks since 2020. Our findings suggest that both patient choices about seeking care and outcomes after experiencing a cardiac emergency also have changed,” said senior author John Hsu, MD, MBA, MSCE, faculty member and director of the Program for Clinical Economics and Policy Analysis at the Mongan Institute at MGH. “Had we not examined mortality using death certificate data, the increases in population cardiac mortality could have gone unnoticed.”

Authorship: In addition to Wasfy, Mass General Brigham authors include Yuqian Lin, Mary Price, Deborah Blacker, and John Hsu. Additional authors include Joseph P. Newhouse.

Disclosures: Hsu reported receiving consulting fees from Cambridge Health Alliance, Brandeis University, and Alta Med and giving keynote speeches for Invitx and the University of South Carolina outside the submitted work. No other disclosures were reported.

Funding: This work has been supported by a grant from the National Institutes of Health (U01AG076478).

Paper cited: Wasfy JH et al. “Post-Pandemic Elevated and Persistent Cardiac Mortality Rates” JAMA DOI: 10.1001/jamanetworkopen.2025.12919