Over the past five decades, the landscape of cardiovascular mortality in the United States has shifted dramatically. According to a new study published June 25 in the Journal of the American Heart Association, deaths from heart attacks—formally known as acute myocardial infarctions—have declined by 89% since 1970. Once the dominant cause of death from heart disease, heart attacks now account for a far smaller share of cardiovascular fatalities.
This decline marks a major public health achievement, driven by improvements in emergency care, preventive measures, and treatment protocols. However, as fewer Americans die from heart attacks, other forms of heart disease are becoming increasingly lethal. The study reveals that heart failure, hypertension-related heart disease, and arrhythmias have all seen substantial increases in mortality over the same period.
While overall deaths from heart disease have dropped by 66% since 1970, it remains the leading cause of death nationwide. In 2022, ischemic heart disease made up just 53% of heart-related fatalities, down from 91% in 1970. Meanwhile, other cardiovascular conditions now account for 81% of deaths linked to heart disease, including:
- Heart failure: 81% increase in deaths
- Hypertensive heart disease: 106% increase
- Arrhythmias: 450% increase
These findings underscore a critical shift: surviving a heart attack has become more common, but other cardiovascular threats are on the rise and demand renewed attention.
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Heart Attack Deaths Have Declined — But Other Cardiac Threats Are Rising
While heart attacks once dominated the landscape of cardiovascular mortality in the U.S., recent data shows a significant shift: deaths from heart attacks have dropped dramatically in recent decades. But the story doesn’t end there. Other, often chronic, heart conditions are now on the rise—and they’re taking center stage.
Dr. Jayne Morgan, a cardiologist and vice president of medical affairs at Hello Heart, told Healthline that the decline in fatal heart attacks doesn’t mean fewer heart attacks are happening. Rather, more people are surviving them.
“The report doesn’t indicate a drop in the number of myocardial infarctions,” said Dr. Morgan, who was not involved in the study. “What we’re seeing is a reduction in heart attacks as a leading cause of death. That’s largely due to our strength in medical science and its application—not prevention.”
In other words, more people are living through heart attacks thanks to faster emergency response, better medications, advanced procedures, and the widespread availability of life-saving devices.
From Fatal Events to Chronic Conditions
As survival rates improve, the consequences of non-fatal heart attacks are becoming more apparent. Dr. Morgan explained that surviving a heart attack often marks the beginning of a long-term struggle with chronic cardiovascular conditions such as heart failure and arrhythmias.
Dr. Cheng-Han Chen, a board-certified interventional cardiologist who was also not involved in the report, echoed this point.
“Heart attacks can cause permanent damage to the heart muscle,” he said. “Depending on the severity, this damage may compromise the heart’s ability to pump effectively, eventually leading to heart failure.”
Heart failure, Chen emphasized, doesn’t mean the heart has stopped. “It just means the heart isn’t functioning optimally. It can range from very mild to severe, and many people can manage it with medications and lifestyle changes.”
Longer life expectancy after a heart attack also means more time for other age-related cardiovascular conditions to develop—such as hypertension-related heart disease and arrhythmias.
Lifestyle and Socioeconomic Factors at Play
While modern medicine has helped reduce death from acute heart attacks, Dr. Morgan warns that the American lifestyle continues to fuel the rise of other heart conditions.
“Our society struggles with obesity, high blood pressure, sedentary habits, processed foods, smoking, elevated cholesterol, diabetes, and chronic stress—all of which contribute to chronic inflammation and cardiovascular risk,” she said.
Socioeconomic factors further complicate prevention efforts. Limited access to healthcare, food insecurity, and chronic stress create disparities in health outcomes. Dr. Morgan also noted that certain pregnancy-related complications—such as preeclampsia and gestational diabetes—significantly raise a woman’s lifetime risk of heart disease and remain major contributors to maternal mortality.
Still, the decline in heart attack fatalities reflects progress. It shows that awareness, early intervention, and improved treatment protocols are making a measurable impact.
Alarming Rise in Arrhythmia-Related Deaths
The most concerning trend in the recent report is a sharp increase in deaths linked to arrhythmias—irregular heart rhythms that, in some cases, can be fatal.
Arrhythmias come in several forms:
- Bradycardia – a slow heart rate
- Tachycardia – a fast heart rate
- Ventricular arrhythmias – originating in the lower heart chambers
- Supraventricular arrhythmias – including atrial fibrillation, arising in the upper chambers
While many arrhythmias are benign, others can disrupt the heart’s ability to maintain proper blood flow, threatening the function of critical organs like the brain and lungs.
Annual physicals that include cardiac evaluations can help detect arrhythmias early. And if you can feel your heartbeat without touching your chest—or notice fluttering, pounding, or skipped beats—it may be time to talk to your doctor.
“Reducing arrhythmia risk after a myocardial infarction is essential,” said Dr. Morgan. “Ventricular arrhythmias, in particular, can be life-threatening.”
She recommends a multifaceted approach that includes the “foundational four” drug regimen for heart failure with reduced ejection fraction (HFrEF), along with statins, cardiac rehab, implantable defibrillators, and sleep apnea treatment.
The AHA’s ‘Essential Eight’ for a Healthier Heart
To support long-term heart health, the American Heart Association promotes the “Essential Eight”—a comprehensive set of lifestyle recommendations:
- Eat a heart-healthy diet
- Increase physical activity
- Avoid tobacco
- Get sufficient sleep
- Maintain a healthy weight
- Control cholesterol levels
- Manage blood sugar
- Monitor and manage blood pressure
These guidelines apply to adults and children alike. More information is available at the AHA’s Essential Eight website.
Frequently Asked Questions
Are heart attacks still common in the U.S.?
Yes, heart attacks are still common, but thanks to advancements in emergency care and treatment, they are less likely to be fatal today than in decades past.
If fewer people are dying from heart attacks, why is heart disease still the leading cause of death?
While deaths from heart attacks have declined, other forms of heart disease—such as heart failure, hypertension-related heart disease, and arrhythmias—are on the rise, contributing to continued high mortality from cardiovascular conditions.
What’s causing the increase in deaths from other heart conditions like arrhythmias and heart failure?
More people are surviving heart attacks but living longer with damaged heart tissue, which can lead to chronic issues like heart failure and dangerous arrhythmias. Aging, lifestyle factors, and better detection may also contribute.
What is heart failure, and is it the same as a heart attack?
No. A heart attack is a sudden event caused by blocked blood flow, while heart failure is a chronic condition where the heart doesn’t pump blood effectively. Many people live with heart failure for years with proper treatment.
What are arrhythmias, and why are they dangerous?
Arrhythmias are irregular heartbeats. Some are harmless, but others—especially ventricular arrhythmias—can disrupt blood flow and be life-threatening if not treated promptly.
Conclusion
The sharp decline in heart attack deaths marks a significant public health achievement, reflecting decades of medical progress in emergency response, treatment, and patient care. Yet, this success story comes with a new challenge: a rising tide of chronic and often fatal heart conditions like heart failure, arrhythmias, and hypertension-related disease.
These trends highlight a critical truth—surviving a heart attack is no longer the finish line, but the beginning of a lifelong journey of cardiovascular management. As heart disease evolves, so too must our strategies for prevention, early detection, and long-term care.
