Heart attacks have become significantly more survivable over the past five decades and are no longer the leading cause of heart disease-related deaths in the United States, according to a new study published on June 25 in the Journal of the American Heart Association.
The report highlights an 89% decrease in deaths from acute myocardial infarctions (heart attacks) between 1970 and 2022. Once accounting for 91% of all cardiovascular-related deaths in 1970, ischemic heart disease — which includes heart attacks — now represents just 53% of those deaths.
This dramatic improvement is largely credited to advances in emergency care, early intervention, public health awareness, and preventive cardiology. As a result, overall mortality from heart disease has declined by 66% since 1970. Despite these gains, heart disease remains the leading cause of death in the U.S.
However, as survival rates for heart attacks improve, deaths from other forms of heart disease are on the rise. The study notes that these now account for 81% of all heart disease-related fatalities. Key contributors to this shift include:
- Heart failure, with an 81% increase in related deaths
- Hypertensive heart disease, showing a 106% rise in fatalities
- Arrhythmias, which have seen a dramatic 450% increase in deaths
These emerging trends underscore the need for broader cardiovascular care strategies that go beyond treating heart attacks, focusing on prevention, early detection, and management of a wider range of heart conditions.
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Heart Attack Deaths Decline, but Incidence Remains Steady
Despite a sharp decrease in heart attack-related deaths in recent decades, the actual number of heart attacks may not have declined, according to Dr. Jayne Morgan, a cardiologist and vice president of medical affairs at Hello Heart. Speaking to Healthline, Dr. Morgan—who was not involved in the recent study—emphasized that the data points to improved survival, not necessarily a reduced occurrence.
“I did not note a decline in myocardial infarctions themselves, but rather a decline in heart attacks being the primary cause of death,” she explained. “As Americans, we are not particularly strong in prevention. Our true strength lies in medical science and its practical application.”
Dr. Morgan noted that the findings suggest heart attacks are far more survivable today than they were 55 years ago. This progress is largely attributed to advancements in emergency care, pharmacology, and medical technology.
“Emergency physicians are now far better equipped to save lives during heart attacks,” she added, “thanks to the availability of modern medications, lifesaving procedures, and cutting-edge medical devices.”
Non-Fatal Heart Attacks Linked to Long-Term Cardiovascular Complications
Non-fatal heart attacks, while no longer the leading cause of cardiovascular deaths, often trigger a cascade of long-term health issues, according to experts.
Dr. Jayne Morgan, a cardiologist and medical affairs executive at Hello Heart, explained that surviving a heart attack often marks the beginning of a chronic journey with heart disease. “The non-fatal heart attack becomes the catalyst for a chain of events leading to long-term cardiovascular conditions such as heart failure and arrhythmias,” she noted.
Dr. Cheng-Han Chen, an interventional cardiologist not involved in the recent study, echoed that sentiment. “Patients who might not have survived a heart attack decades ago are now living longer, but with the ongoing consequences of that initial cardiac event,” he told Healthline.
Chen explained that non-fatal heart attacks frequently cause damage to the heart muscle, with the severity of that damage depending on the intensity and duration of the attack. This damage can weaken the heart’s pumping ability, potentially leading to heart failure.
However, he emphasized that heart failure is often misunderstood. “It doesn’t mean the heart has stopped working completely,” said Chen. “It means the heart is no longer functioning at its optimal capacity. This can range from very mild to extremely severe.”
He added that many patients can live with mild heart failure for years, sometimes without major lifestyle limitations, especially when the condition is well-managed with medication.
Surviving a heart attack typically extends life expectancy—but with age comes increased vulnerability to other heart-related conditions. As people live longer post-heart attack, they are more likely to develop chronic issues such as heart failure, hypertension-related heart disease, and arrhythmias—all of which are strongly linked to aging.
Lifestyle Choices Play a Critical Role in Heart Health
The typical American lifestyle continues to place many individuals at increased risk for serious cardiovascular conditions, including heart failure, hypertension, and arrhythmia, according to Dr. Jayne Morgan, cardiologist and vice president of medical affairs at Hello Heart.
“Our lifestyle is often defined by a cluster of risk factors,” Dr. Morgan explained. “Obesity, high blood pressure, lack of physical activity, diets high in processed and fast foods, smoking, elevated cholesterol, diabetes, and chronic stress all contribute to long-term cardiovascular strain and inflammation.”
Beyond these behaviors, socioeconomic factors further complicate efforts to improve heart health. Many individuals face structural barriers that make it difficult to access nutritious foods, receive adequate healthcare, or maintain consistent preventive care.
“Pregnancy-related complications such as gestational hypertension, preeclampsia, and gestational diabetes also significantly elevate a woman’s lifetime risk of developing heart disease,” Dr. Morgan added. “These conditions remain leading contributors to maternal mortality in the United States.”
Despite these ongoing challenges, the overall decline in heart disease fatalities suggests that progress is being made in addressing certain lifestyle-related risk factors, particularly through improved awareness, early detection, and treatment interventions.
Sharp Rise in Arrhythmia-Related Deaths Highlights Need for Early Detection and Prevention
The recent report revealed a striking increase in deaths linked to arrhythmias—abnormal heart rhythms that can range from mild to life-threatening. Among all cardiovascular conditions examined, arrhythmia-related fatalities experienced the most dramatic surge, prompting concern among medical experts.
Understanding Arrhythmias
Arrhythmias occur when the heart beats too slowly, too quickly, or irregularly. The four primary types include:
- Bradycardia – abnormally slow heart rate
- Tachycardia – abnormally fast heart rate
- Ventricular arrhythmia – originates in the ventricles (the lower chambers)
- Supraventricular arrhythmia – begins above the ventricles, including atrial fibrillation (AFib), the most common irregular heartbeat
While many arrhythmias are harmless and may cause no symptoms, others can disrupt the heart’s ability to pump blood effectively. When blood flow is compromised, vital organs such as the brain, lungs, and kidneys may be at risk of serious damage.
“Reducing the risk of arrhythmias after a myocardial infarction is crucial,” said Dr. Jayne Morgan, cardiologist and VP of medical affairs at Hello Heart. “Irregular heart rhythms—particularly ventricular arrhythmias—can be fatal if not managed properly.”
Post-Heart Attack Management and Prevention
For heart attack survivors, arrhythmia prevention is a critical part of long-term care. Dr. Morgan recommended several clinical strategies to lower the risk of fatal arrhythmias, including the use of a treatment plan known as the “foundational four” for managing Heart Failure with Reduced Ejection Fraction (HFrEF). This approach combines four classes of medications proven to improve heart function and outcomes.
Additional interventions may include:
- Statins to reduce cholesterol and inflammation
- Cardiac rehabilitation programs to support recovery and improve physical conditioning
- Implantable cardioverter-defibrillators (ICDs) for patients at high risk of sudden cardiac death
- Management of sleep apnea, a known contributor to heart rhythm disturbances
- Lifestyle changes to reduce risk factors and improve heart function
Importance of Regular Monitoring
Annual checkups that include heart health assessments are essential for early detection of arrhythmias. Dr. Morgan also advises patients to pay attention to any unusual heart sensations.
“If you can feel your heart beating—especially without placing your hand on your chest—it’s a good idea to consult a physician,” she said. This sensation could indicate an irregular rhythm that warrants evaluation.
The AHA’s Essential Eight for Heart Health
To promote cardiovascular wellness and reduce the risk of arrhythmias and other heart-related conditions, the American Heart Association (AHA) recommends following its Essential Eight:
- Eat a heart-healthy diet
- Be physically active
- Avoid tobacco products
- Get sufficient, quality sleep
- Maintain a healthy weight
- Manage cholesterol levels
- Regulate blood sugar
- Control blood pressure
The AHA also offers guidance tailored for children to support lifelong heart health. For more, visit the AHA’s Essential Eight resource page.
Frequently Asked Questions
Why are heart attacks no longer the leading cause of heart-related deaths in the U.S.?
Heart attack deaths have declined significantly due to advances in emergency care, medications, early detection, and improved public awareness.
What is now the leading cause of heart-related deaths in the U.S.?
Other cardiovascular conditions—such as heart failure, hypertension-related heart disease, and arrhythmias—now account for the majority of heart-related deaths.
Have heart attacks become less common or just less deadly?
Heart attacks haven’t necessarily become less common, but they are now much more survivable thanks to medical advancements and faster treatment response.
Why are deaths from conditions like heart failure and arrhythmias increasing?
These increases are linked to aging populations, long-term effects of surviving heart attacks, poor lifestyle habits, and limited access to preventive care.
How can individuals reduce their risk of developing heart disease today?
Following a heart-healthy lifestyle—including proper diet, regular exercise, managing stress, avoiding smoking, and monitoring blood pressure and cholesterol—can significantly reduce heart disease risk.
Conclusion
While the decline in heart attack-related deaths marks a significant achievement in cardiovascular medicine, the overall battle against heart disease is far from over. The sharp rise in fatalities from other heart-related conditions—such as heart failure, hypertension, and arrhythmias—underscores the evolving challenges facing public health.
These trends highlight the importance of continued investment in preventive care, lifestyle education, early detection, and management of all forms of heart disease. As Americans live longer, a renewed focus on comprehensive cardiovascular health—not just heart attack prevention—is essential for reducing mortality and improving quality of life across the population.
