In the United States, cardiovascular deaths that were not directly due to COVID-19 surged early in the pandemic. The postponement of procedures, the extra strain on services, and patients’ avoidance of hospitals may partly explain the increase.

About one-third of the 225,530 “excess deaths” in the U.S. during the first months of the pandemic were not directly due to COVID-19, according to a recent study.

Despite this additional death toll, other research showed that the number of people admitted to the hospital with cardiovascular conditions fell sharply in March 2020, coinciding with the rise in COVID-19 cases.

“Hospital visits for heart attacks and other cardiac conditions declined markedly during the pandemic, fueling physicians’ concerns that people with acute conditions may be staying at home due to fear of exposure to COVID-19,” says Dr. Rishi K. Wadhera, a cardiologist at the Beth Israel Deaconess Medical Center (BIDMC) in Boston, MA.

New research adds to these concerns. According to the study, which Dr. Wadhera led, cardiovascular deaths unrelated to COVID-19 increased in New York State, New Jersey, Michigan, and Illinois during the first wave of the pandemic relative to cardiovascular deaths in the same period of 2019.

In New York City, which the first wave hit particularly hard, deaths from ischemic heart disease (which results from narrowed cardiac arteries) increased by 139%, and deaths from hypertensive disease (due to high blood pressure) increased by 164%.

“These data are particularly relevant today, as we find ourselves in the midst of a surge in COVID-19 cases that looks to be exceeding what we experienced last spring,” says senior author Robert Yeh, director of the Smith Center for Outcomes Research at BIDMC.

“Ensuring that patients with cardiovascular disease continue to receive necessary care during our public health response to the pandemic will be of paramount importance,” he adds.

The researchers drew on data from the National Center for Health Statistics to compare cardiovascular death rates at the start of the pandemic (from March 18, 2020, to June 2, 2020) with those during the preceding 11 weeks.

To account for seasonal trends, they then compared this figure with the change in cardiovascular death rates over the same period in 2019.

Overall, the rate of deaths due to ischemic heart disease increased by 11% over this period in 2020 compared with the previous year. The rate of deaths resulting from hypertensive disease increased by 17%.

There was no increase in death rates from heart failure, cerebrovascular disease (such as strokes), or other circulatory diseases.

The surge in cardiac death rates was concentrated in New York State, New Jersey, Michigan, and Illinois, which were among the states most affected by COVID-19 during the first wave of the pandemic.

One exception was Massachusetts, which did not see increases in cardiac death rates, despite being an epicenter of COVID-19 cases.

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