A dramatic improvement in heart attack survival odds has reduced overall heart disease death rates in the United States, but a new study suggests that chronic conditions like high blood pressure and heart failure are becoming more fatal.
While lower smoking rates, better tools to rapidly diagnose and treat heart attacks, and newer medicines have all boosted heart attack survival rates, this is only part of the picture, says lead study author Sara King, MD, an internal medicine resident at Stanford University in California. “It seems the burden of heart disease mortality is shifting to heart failure and other more chronic conditions,” Dr. King says.
Study Identified Major Shifts in Cardiac Death Causes
King and her team examined age-adjusted mortality data from 1970 to 2022 for American adults 25 and older, including information on deaths from all forms of heart disease as well as from specific cardiovascular causes like heart attacks, heart failure, high blood pressure, and heart rhythm disorders.
Overall the number of heart disease deaths per 100,000 people dropped from 761 at the start of the study to 258 by the end, a 66 percent decline. Over this same period, heart attack deaths per 100,000 people dropped from 354 to 40, the study found.
However, deaths from other heart-related causes surged during the study period:
- Heart failure deaths per 100,000 people climbed from 13 to 32.
- High blood pressure deaths increased from 16 to 33.
- Heart rhythm disorder deaths surged from 2 to 11.
One limitation of the study is that the data came from hospital billing records, which may not always accurately capture patients’ medical conditions, and from death certificates, which may not always reflect all of the underlying health issues that contribute to a fatality.
Why Have Heart Attack Death Rates Plummeted?
The study wasn’t designed to prove whether or how any specific changes in prevention, diagnosis, or treatment of heart attacks or heart disease might contribute to changes in mortality rates over time.
However, medical advances in these areas have likely had an impact, says Yu Chen, PhD, MPH, a professor of population health at the New York University Grossman School of Medicine, who wasn’t involved in the new study.
“Since the 1960s, treatments like CPR, defibrillators, heart procedures, and medications have greatly reduced deaths from heart attacks,” Dr. Chen says. “New tools and drugs — such as imaging, stents, statins, and faster emergency care — have continued to improve survival and prevent future heart problems.”
Still, a growing number of Americans are living with risk factors for heart disease like obesity, inactivity, type 2 diabetes, and high blood pressure that can increase their odds of having a heart attack as well as chronic heart diseases, Chen says.
“With better treatments for heart disease, people live longer — from an average of about 71 years in 1970 to 77.5 in 2022,” Chen says. “More are living with long-term heart issues, contributing to deaths from chronic heart conditions like heart failure and arrhythmias.”
Is There a Way to Reduce Deaths From Chronic Heart Disease?
To stop or reverse the increasing mortality trends for chronic heart diseases will require more research into how heart attacks and heart disease impact not just middle-aged men but also women and other underserved and understudied populations, says Joan Briller, MD, a professor of clinical medicine at the University of Illinois in Chicago, who wasn’t involved in the new study.
“It is saddening,” says Dr. Briller, describing the increase in deaths due to chronic heart disease despite the progress made in reducing heart attack fatalities.
Turning this around will require more research into the best ways to address some of the root causes of heart disease, Briller says. “This will require several approaches including addressing the gender differences between men and women, educational campaigns that address lifestyle, addressing social determinants of health, and improved access to care.”
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