The Pandemic That Never Left

The COVID-19 pandemic which began in early 2020 had notable effects on public health in the United States (US). The pandemic resulted in direct morbidity and mortality from the effects of COVID-19 but also led to significant disruptions to socioeconomic infrastructure in the US in an effort to contain the pandemic. Although COVID-19 was the third leading cause of mortality in 2021, mortality attributed to COVID-19 remained behind cardiovascular disease and malignancy as the two leading causes of death throughout the early years of the pandemic. Similarly to other diseases, heart failure mortality rates increased in the early phases of the pandemic.1Kobo O Abramov D Fudim M Sharma G Bang V Deshpande A Wadhera RK Mamas MA. Has the first year of the COVID-19 pandemic reversed the trends in CV mortality between 1999 and 2019 in the United States?.European Heart Journal-Quality of Care and Clinical Outcomes. 2023; 9: 367-376PubMed Google Scholar However, the trends in mortality related to COVID-19 versus the trends in mortality related to heart failure/cardiomyopathy (HF) since the start of the COVID-19 pandemic have not been well characterized, particularly using the latest provisional 2023 mortality data. Therefore, we queried the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database to evaluate these trends. Highlighting the mortality burden related to HF versus COVID-19 can have important implications for ongoing efforts to combat continuing and evolving threats to public health. Deaths occurring within the Unites States in individuals age 25 years or older were extracted from the CDC WONDER database.2CDC WONDERUnited States Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS), 2024https://wonder.cdc.gov/mcd-icd10-provisional.htmlGoogle Scholar We identified causes of mortality with underling or contributing COVID-19 (U07.1,U09.9) or HF/cardiomyopathy (I11.0, I13.0, I13.2, I50, I42, O90.3) between 2011 and provisional 2022 and 2023 data. Age-adjusted mortality rates (AAMR) per 100,000 population, with 95% Confidence Intervals, were also determined. AAMRs were calculated by standardizing the deaths to the year 2000 U.S. population. AAMRs related to HF and COVID-19 between 2011 and provisional 2023 data are shown in Figure 1. AAMR related to HF was 145.8 (145.3-146.3) in 2011, 159.6 (159.1-160.1) in 2019, peaked at 185.4 (184.8-185.9) in 2021, and declined to 175.6 (175.1-176.1) in provisional 2023 data. AAMR related to COVID-19 peaked in 2021 at 177.7 (177.2-178.3) and declined to 28.2 (27.9-28.4) in provisional 2023 data. Mortality trends related to HF compared with mortality related to COVID-19 during the first four years of the pandemic demonstrate several important findings. At the peak of the pandemic in 2021, mortality related to HF was higher than mortality related to COVID-19. Mortality related to HF peaked in 2021 and declined in 2022 and 2023, although remained above pre-pandemic rates. These results highlight that mortality related to HF dwarfed COVID-19-related mortality rates during the first four years of the COVID-19 pandemic. The period between 2020 and 2023 in the US led significant societal efforts and public health mobilization to combat the COVID-19 pandemic. At the start of the pandemic, the US implemented interventions that led to profound socioeconomic consequences on employment, education, and other aspects of public health. Additionally, as of January 2023, the federal government spent approximately $4.6 trillion on efforts to combat and recover from the COVID-19 pandemic.3COVID-19 Relief: Funding and Spending as of Jan. 31, 2023. https://www.gao.gov/products/gao-23-106647. Accesed 2/13/2024.Google Scholar These efforts may be contrasted to US spending on HF, which reaches approximately $40-60 billion dollars yearly. Although the mortality related to COVID-19 has eased significantly from 2021 highs, COVID-19-related mortality was lower than HF-related mortality both at its peak and throughout the pandemic. This raises important public health questions about the adequacy of the US response to the mortality related to the HF crisis that, while easing off 2021 highs, has continued to increase over the last decade in the US. Novel public health efforts involving a broad group of stakeholders are therefore urgently needed to combat the pandemic of HF in the US, particularly in an era of knowledge gaps about the burden of HF4Lam CS Harding E Bains M Chin A Kanumilli N Petrie MC Pohja-Hutchison P Yang J Butler J Identification of urgent gaps in public and policymaker knowledge of heart failure: Results of a global survey.BMC Public Health. 2023; 23: 1-10Crossref PubMed Scopus (1) Google Scholar and underutilization of life saving medical therapies.5Shahid I Khan MS Fonarow GC Butler J Greene SJ. Bridging gaps and optimizing implementation of guideline-directed medical therapy for heart failure.Progress in Cardiovascular Diseases. 2024; Crossref PubMed Scopus (0) Google Scholar Comparison of mortality related to COVID-19 versus HF over the last several years highlights discrepant public health responses to these health crises, which may serve as another launching point for further discussion about how to improve the rising mortality related to HF in the US. Abdul Mannan Khan Minhas: Formal analysis, Writing – review & editing. Marat Fudim: Conceptualization, Writing – review & editing. Dmitry Abramov: Project administration, Writing – original draft, Writing – review & editing.