Abstract 4369832: The Impact of COVID-19 pandemic on Mortality and Place of Death among Patients with Ischemic Heart Disease in the United States (2018–2023): A nationwide analysis

Abstract

Background: The COVID-19 pandemic disrupted health care systems and emergency care access across the United States. Research Question: What was the impact of COVID-19 on mortality of patients with IHD and their places of death? Methods: We used the CDC WONDER database to identify deaths due to IHD (ICD-10 codes I20-I25) from 2018-2023. The study was divided into pre-COVID (2018–2019), during COVID (2020–2021), and post-COVID (2022–2023) periods. Deaths were categorized by place of death: inpatient, outpatient or ER, decedent’s home, hospice facility, and nursing home/long term care. Adjusted mortality rates (AAMRs) per 100,000 population were stratified by age, sex, race, ethnicity and region. Results: Overall, 2,205,804 individuals died due to IHD and the AAMR increased from 89.4 per 100,000 pre-COVID to 92.2 during COVID, before declining to 84.9 in the post-COVID era. AAMR for individuals having concomitant IHD and Covid-19 decreased by 52.5% from 10.76 during the pandemic to 5.11 after the pandemic. (Table 1) Place of death analysis revealed substantial shift toward home deaths during the pandemic which increased from 38.7% (264,005 of 682,196) to 44.9% (318,249 of 708,342) during COVID, remaining elevated post-COVID (44.7%). Inpatient deaths fell from 23.6% to 21.8% during COVID and Deaths in outpatient/ER (14.0% to 13%), nursing homes (19.5% to 16.7%), and hospice (4.0% to 3.6%) also declined. (Table 2) Young adults aged 25-44 had the largest AAMR rise during COVID (+12.5%), with smaller increases in those aged 45-64 (+6.9%) and ≥65 (+2.1%). Geographically, AAMR increased the highest in the South and West (+4.5%) with greatest post-COVID declines in the Northeast (-11.7%). Hispanic individuals saw a 6.8% increase in AAMR during COVID and a 13.4% decline after. Increases in AAMR during COVID were highest among Black (+6.9%), Asian (+6.6%), and Pacific Islander (+6.4%) individuals, while White individuals had a smaller rise (+2.7%). Conclusion: COVID-19 pandemic was associated with a temporary rise in IHD mortality and a substantial shift in place of death toward home, which continued post-COVID. Although overall IHD mortality declined post-pandemic, this recovery was uneven across age, race, and region. This highlights persistent disparities and long-term changes in healthcare utilization and end-of-life care patterns following the pandemic and underscore the urgent need for targeted interventions to improve healthcare access.