The Increase in "Heart Failure Deaths" Post-COVID ─ The Quiet Progression of the "Aftermath of Chronic Diseases"

"Pandemic death tolls" are often associated with the fatality rate of the infection itself or the memory of overwhelmed healthcare systems. However, the "real aftermath" of the COVID-19 pandemic might be infiltrating society in a quieter and more prolonged manner. A report has sounded the alarm that heart failure deaths are accelerating in the United States as a prominent example.

Heart failure deaths are not "sudden attacks" but the culmination of accumulated damage

Heart failure is not an event that occurs "suddenly one day" like a heart attack or stroke. Instead, it is a condition where the heart weakens over time and can no longer pump enough blood throughout the body. This is why the deterioration progresses gradually when daily routines such as blood pressure management, diabetes treatment, weight management, medication adherence, and regular check-ups are disrupted.

The article suggests that this very "gradual" process may have surfaced abruptly since the COVID-19 pandemic. Across the United States, the age-adjusted heart failure mortality rate had been declining from 1999 to around 2011, but then it reversed. Furthermore, since 2020, the increase has accelerated, and this trend continues.

In 2024, heart failure as the "underlying cause" exceeded 92,000 deaths—"related deaths" exceeded 423,000

The numbers are even more daunting. In 2024, heart failure was recorded as the "underlying cause" of over 92,000 deaths in the United States and was involved as a "contributing cause" in over 423,000 deaths. While it is expected that mortality rates are high among the elderly, the strong increase among younger to middle-aged groups—a "reversal phenomenon"—is causing concern in clinical settings.

What is important here is that the simple causality of "died of heart failure because of COVID-19 infection" cannot explain the situation. Co-author Harlan Krumholz (Yale University) points out that the background may involve not a single cause but a combination of factors: ① worsening cardiovascular risks such as diabetes, obesity, and hypertension, ② issues within the healthcare system and structural problems, and ③ "mixed factors" such as interruptions in medical visits, delayed diagnoses, and follow-up discontinuities during the pandemic.

"The increase is among younger generations/Black people/rural areas/the South and Midwest"

The groups where the increase is notable are also indicated. The rise is sharp among those under 65, males, Black individuals, rural residents, and those living in the South and Midwest. This appears to be less about a "new virulence of the virus" and more about the expansion and entrenchment of pre-existing health and access disparities exacerbated by the crisis.

In fact, in the field of cardiology in the United States, there has long been concern about the increase in heart failure deaths among younger people and racial disparities. For example, a presentation from Duke University highlights the importance of improving access, including preventive awareness, early diagnosis, and telemedicine, in addition to the increase in heart failure deaths among the young.

The underlying "persistent risk factors": Hypertension, diabetes, obesity

This news may seem like a story about "heart failure" alone, but it is actually continuous with the overall trend of cardiovascular risk in the United States. A statistical report from JACC introduced by the American College of Cardiology (ACC) shows the precarious foundations: hypertension affects about 1 in 2 adults (by current guideline standards), with treatment and control rates stagnating for years, obesity reaching about 40% of adults, and diabetes increasing.

Heart failure is likely to manifest as a result of these risk factors placing a long-term burden on the heart. Thus, considering that lifestyle changes during the pandemic (reduced physical activity, weight gain, increased stress) and interruptions in medical visits further elevated the already progressing risk, the report's expression of "acceleration" makes sense.

Reactions on social media: Empathy, anger, and "controversy" arise simultaneously

When this type of news spreads on social media, reactions generally split into three directions.

1) "COVID is not over" type: Alarmed by the shadow of chronic diseases
Reactions such as "Even though the topic of infection numbers has decreased, the consequences are coming" and "The period away from medical care is frightening" are common. Considering that heart failure is a disease sensitive to the "continuity of life and medical care," this is an intuitively understandable response.

2) "What is the cause" type: Aftereffects of infection vs. lifestyle habits vs. healthcare collapse
On Hacker News, discussions touch on the boundary cases where COVID-19 "accelerated" other diseases (such as heart failure), with the interpretation of cause of death counts and data handling becoming points of contention.
In this context, voices emphasizing system factors such as "gaps in medical care," "delayed diagnoses," and "avoidance of emergency visits" are likely to emerge.

3) "Vaccine controversy" type: Baseless assertions spread easily
Posts and speculation that easily link cardiovascular events to COVID-19 vaccines have repeatedly been problematic in the past. The ACC's commentary also points out the importance of experts providing accurate information, given the spread of misinformation surrounding incidents like the cardiac arrest of athletes.

In reality, there is a strong desire on social media to "explain with a single factor," making it difficult for the subtle and complex explanations involving multiple factors (metabolic risk + medical access + post-infection effects) to reach people. This is why, as emphasized in the current report, the perspective that "multiple forces worked simultaneously" rather than a "new single cause" is crucial as a starting point for discussion.

So, what should be done: A "two-pronged approach" for individuals and society

The acceleration of heart failure deaths is not an issue that can be stopped by individual efforts alone. However, there are measures that can be taken by both individuals and society.

• Individual side: Make it a habit to "visualize" blood pressure, weight, and blood sugar, and reduce overlooking symptoms (shortness of breath, swelling, fatigue).

• Societal side: If regional, racial, and income disparities are linked to mortality, it becomes essential to establish a foundation for access to primary care, medication continuity, telemedicine, and preventive education. Duke University's insights also emphasize a comprehensive approach that includes prevention, early diagnosis, and remote care, not just treatment.

The pandemic was not only an infectious disease crisis but also a social crisis that shook the management of chronic diseases. The acceleration of heart failure deaths indicates the reality that "it's not over when hospital beds are available." Continuity of medical care, support for lifestyle habits, and systems that do not widen disparities. These are the most mundane yet crucial themes for preparing for the next crisis.