Shifting Burdens: U.S. Cardiovascular Mortality Trends during the COVID-19 Pandemic

BACKGROUND: Cardiovascular conditions such as cardiac arrest, arrhythmias, myocarditis, pericarditis, and pulmonary embolism (PE) contribute substantially to mortality. The COVID-19 pandemic introduced both direct (infection-related) and indirect (healthcare disruption) risks, potentially altering these trends. OBJECTIVE: To assess the shifts in U.S. mortality from major cardiovascular causes before and after the COVID-19 pandemic, with emphasis on sex- and race-specific disparities. METHODOLOGY: We analyzed national death certificate data from the Centers for Disease Control and Prevention-Wide Ranging Online Data for Epidemiologic Research Multiple Cause of Death database (2015-2023). Outcomes included cardiac arrest (I46), arrhythmias (I47-I49), myocarditis (I40-I41, I51.4), pericarditis (I30-I32), and PE (I26). Age-standardized mortality rates (ASRs) were calculated using the 2000 U.S. standard population. Rate ratios (RRs) for the post- versus prepandemic periods were estimated using Poisson regression, stratified by sex and race. RESULTS: Mortality increased across all outcomes in the postpandemic period. PE showed the largest relative rise (ASR: +31.4%; RR: 1.31, 95% confidence interval [CI]: 1.30-1.32), followed by myocarditis (+25.1%; RR: 1.25, 95% CI: 1.19-1.30), pericarditis (+21.4%; RR: 1.21, 95% CI: 1.19-1.24), and arrhythmias (+23.0%; RR: 1.23, 95% CI: 1.23-1.23). Cardiac arrest increased more modestly (+9.8%; RR: 1.09, 95% CI: 1.09-1.09). Men had consistently higher absolute rates, while Black and American Indian/Alaska Native populations experienced the steepest relative increases. CONCLUSION: The COVID-19 era was associated with sustained increases in U.S. cardiovascular mortality, particularly PE and arrhythmias. Disproportionate impacts among racial minorities highlight the urgent need for equitable access to preventive care, acute cardiovascular services, and long-term surveillance.