key: cord-0993072-a5k61ntq authors: Faust, J. S.; Lin, Z.; Wright, K. N.; Di Iorio, M. A.; Walsh, C. D.; Krumholz, H. title: Heart disease mortality during the early pandemic period in the United States. date: 2020-08-18 journal: nan DOI: 10.1101/2020.08.16.20175406 sha: 5478962da300b2c19530ab429e211c3eda524db5 doc_id: 993072 cord_uid: a5k61ntq Importance: The coronavirus disease 2019 (COVID-19) outbreak has been associated with decreases in acute myocardial infarction diagnoses (AMI) and admissions in the United States. Whether this affected heart disease deaths is unknown. Objective: To determine whether changes in heart disease deaths occurred during the early pandemic period in the US, we analyzed areas without large COVID-19 outbreaks. This isolated the effect of decreased healthcare-seeking behavior during the early outbreak. Design, Setting, and Participants: We performed an observational study of heart disease-specific mortality using National Center for Health Statistics data (NCHS). Weekly provisional counts were disaggregated by jurisdiction of occurrence during 2019 and 2020 for all-cause deaths, COVID-19 deaths, and heart disease deaths. For the primary analysis, jurisdictions were included if; 1) There was no all-cause excess mortality during the early pandemic period (weeks 14-17, 2020); 2) The completeness of that data was estimated by NCHS to be >97% as of July 22, 2020, and; 3) Decreases in emergency department (ED) visits occurred during the study period. We compared heart disease death rates during the early pandemic period with corresponding weeks in 2019 and a pre-pandemic control period of 2020 as a sensitivity analysis. Incident rate and rate ratios were calculated. Exposure: The US COVID-19 outbreak. Main Outcomes and Measures: Incidence of heart disease deaths. Results: Twelve states met the primary inclusion criteria, capturing 747,375,188 person-weeks for the early pandemic period and 740,987,984 person-weeks for the 2019 control period. The mean incidence rate (per 100,000 person-weeks) for heart disease in states without excess deaths during the early pandemic period was 3.95 (95% CI 3.83 to 4.06) versus 4.19 (95% CI 4.14 to 4.23) during the corresponding period in 2019. The incident rate ratio (2020/2019) was 0.91 (95% CI 0.87 to 0.97). No state recorded an increase from either the corresponding period in 2019 or the 2020 pre-pandemic control period. Two states recorded fewer heart disease deaths. Conclusions and Relevance: This observational study found a decrease in heart disease deaths during the early US outbreak in regions without significant COVID-19 burdens, despite decreases in ED utilization. Long term follow-up data are needed. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 18, 2020. M a i n O u t c o m e s a n d M e a s u r e s : I n c i d e n c e o f h e a r t d i s e a s e d e a t h s . R e s u l t s : T w e l v e s t a t e s m e t t h e p r i m a r y i n c l u s i o n c r i t e r i a , c a p t u r i n g 7 4 7 , 3 7 5 , 1 8 8 p e r s o n -w e e k s f o r t h e e a r l y p a n d e m i c p e r i o d a n d 7 4 0 , 9 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 18, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 18, 2020. M e t h o d s W e p e r f o r m e d a n o b s e r v a t i o n a l c o h o r t s t u d y o f h e a r t d i s e a s e -s p e s p e c i f i c d e a t h i n c i d e n c e r a t e b e t w e e n t h e e a r l y p a n d e m i c p e r i o d , t h e 2 0 1 9 c o n t r o l , a n d t h e 2 0 2 0 p r e -p a n d e m i c c o n t r o l p e r i o d s , w e f u r t h e r c a l c u l a t e d i n c i d e n c e r a t e r a t i o s a n . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 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