America slashes heart attack deaths but faces surge in deadly heart failure and arrhythmias

By Hugo Francisco de SouzaReviewed by Susha Cheriyedath, M.Sc.Jun 26 2025

After five decades of progress against heart attacks, the U.S. now confronts a steep rise in other deadly heart conditions, demanding urgent shifts in public health focus and care.

Study: Heart Disease Mortality in the United States, 1970 to 2022. Image Credit: Roman023_photography / Shutterstock

In a recent study in the Journal of the American Heart Association, researchers leveraged five decades of heart data to unravel long-term heart disease-associated mortality trends and subtypes of concern across the United States (US) to guide future clinical interventions and public health policy.

Study findings reveal that while the overall cardiac picture seems promising, a 66% decrease in overall age‐adjusted heart disease mortality and a substantial reduction in mortality due to acute myocardial infarction and ischemic heart disease, the mortality rates of other heart disease subtypes, such as heart failures and hypertensive heart diseases, are on the rise. Alarmingly, arrhythmia mortality demonstrated a 450% increase, highlighting the need for our health systems to shift their focus and prepare for a wave of lesser-known heart conditions in the US. The study authors note that some of the apparent increases in these conditions may reflect both actual changes and improvements in diagnostic practices over the decades.

It is essential to acknowledge that observed mortality trends may be influenced by changes in disease classification and coding systems over time, including transitions between ICD-8, ICD-9, and ICD-10 coding revisions, which can impact direct comparisons across different decades. The authors also caution that some deaths attributed to heart failure, arrhythmia, or cardiac arrest may have underlying ischemic causes that are not fully captured by death certificate data.

Background

Heart diseases have retained their top spot as the number one cause of annual human mortality in the United States (US) for over a century. To counter this immense public health burden, the US government has implemented several policies aimed at mitigating heart disease-associated mortality, including increasing the national number of coronary care units, launching widespread smoking cessation campaigns, and promoting bystander cardiopulmonary resuscitation (CPR) training in communities, schools, and workplaces.

Alongside unprecedented technological and clinical advancements, these implementations have drastically reduced ischemic (coronary) heart disease-linked morbidity and mortality. While widely recognized and celebrated within the scientific community, these reductions have rarely been statistically investigated and never using long-term trajectory data.

Recent evidence suggests that while the overall burden of heart disease mortality in the US might be on the decline, these observations are primarily due to the US making major strides in ischemic heart disease (IHD) monitoring and treatment. In contrast, these publications report increased mortality rates from other heart conditions such as arrhythmias, heart failure, and hypertensive heart disease.

About the study

The present study aims to address this knowledge gap and inform the nation’s public health framework by leveraging over fifty years of government-maintained heart data, providing a more comprehensive picture of heart disease mortality from 1970 to 2022. It aims to unlink ischemic heart disease success rates from the potentially grim picture posed by other heart conditions, thereby providing vital insight into where cardiovascular medicine has succeeded and where additional research or policy is required.

Study data from 1970 through 2022 were obtained from the US Centers for Disease Control and Prevention’s (CDC’s) Wide‐ranging Online Data for Epidemiologic Research (WONDER) database, an in-depth compilation of cause-of-death-associated demographic and medical information for all deceased US citizens. The current study limited the sample population to adults (aged 25 and above) with a confirmed diagnosis of heart disease associated with their condition. The cause of death was identified and recorded using International Classification of Diseases (ICD-8, ICD-9, ICD-10) codes.

Heart disease records were classified as: 1. heart failure (I50), 2. hypertensive heart disease (I11, I13), 3. cardiomyopathy (I42), 4. valvular heart disease (I34-I38), 5. arrhythmia (I47-I49), and four other subtypes. All analyses were reported as absolute numbers per 100,000 cases, and all statistical models were adjusted for demographic variables, particularly age. Joinpoint regressions were used to plot changes (interval or overall) in disease mortality percentages over time, including a metric termed ‘average annual percentage change (AAPC)’.

Study findings

The final study sample cohort contained almost 230 million US adults, more than doubling from the initial 1970 cohort of 109 million. Over this five-decade period, the WONDER dataset reported 37 million cardiac deaths. Study findings reveal two key points:

Commendable improvements in overall heart disease-associated mortality, primarily mediated by substantial declines in deaths due to ischemic heart diseases. During the period between 1970 and 2022, acute myocardial infarction (AMI) mortality plunged 89%, chronic ischemic disease mortality fell by 71% and overall IHD mortality dropped by an impressive 81% (AAPC -3.1%).

A hidden rise in other cardiac conditions. During the past 50 years, heart failure and hypertensive heart disease have grown in mortality burden by 146% and 106%, respectively. Arrhythmia-related mortality has skyrocketed by 450% during the same period, alongside appreciable increases in valvular, cardiomyopathy, pulmonary heart disease, and cardiac arrest. The study also found a notable decline in mortality from rheumatic heart disease during this period.

The authors observed a temporary spike in heart disease mortality in 2020 during the COVID-19 pandemic, but this did not reverse the overall long-term downward trend.

Conclusions

The present study validates overall declines in heart disease mortality in the US, while highlighting a shifting balance in the nation’s cardiac environment. While ischemic heart disease only contributes to 53% of the US’s cardiac death toll (down from 91% in 1970), non-ischemic subtypes grew from 9% to 47% of cardiac deaths over the past five decades.

Future health strategies must expand beyond coronary care to address this emerging burden. Approaches must include improved surveillance, prevention, and treatment of non-ischemic cardiac conditions, especially among aging populations. The study underscores the importance of targeted research to better understand population differences in mortality trends by age, sex, race/ethnicity, and region, which were not fully explored in this analysis.