Over the past half-century, heart attacks have become significantly more survivable, and for the first time, they are no longer the leading cause of death from heart disease in the United States, according to a new report.
The study, published June 25 in the Journal of the American Heart Association, reveals that deaths from acute myocardial infarction (AMI)—commonly known as heart attacks—have declined by 89% between 1970 and 2022. This dramatic drop marks a major public health achievement, reflecting decades of advances in medical treatment, early detection, and lifestyle changes.
Acute myocardial infarction is a severe form of ischemic heart disease in which blood flow to the heart muscle is abruptly reduced or blocked. In 1970, ischemic heart disease accounted for 91% of all heart disease-related deaths; by 2022, that figure had fallen to 53%.
While overall deaths from heart disease have declined by 66% over the same period, the condition remains the leading cause of death in the U.S. However, as fewer people die from heart attacks, other cardiovascular conditions are now contributing to a larger share of heart-related mortality.
The study highlights notable increases in fatalities from other heart disease subtypes:
- Heart failure deaths have risen by 81%
- Hypertensive heart disease deaths have increased by 106%
- Arrhythmia-related deaths have surged by a striking 450%
These trends reflect a shifting landscape in cardiovascular health, driven by factors such as aging populations, rising rates of obesity and hypertension, and disparities in healthcare access and prevention.
Researchers emphasize that while progress in reducing heart attack mortality is encouraging, growing attention must now turn to the prevention, diagnosis, and treatment of other, increasingly prevalent forms of heart disease.
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Heart Attack Deaths Decline, But Incidence Remains Steady
Despite a sharp decline in heart attack-related deaths in recent decades, the number of heart attacks occurring in the U.S. has not significantly decreased, according to experts.
Dr. Jayne Morgan, a cardiologist and vice president of medical affairs at Hello Heart, told Healthline that the new report reflects improved survival rates rather than a drop in incidence. (Dr. Morgan was not involved in the study.)
“I didn’t see evidence of fewer myocardial infarctions overall,” she said. “What we’re seeing is a decline in heart attacks being the primary cause of death.”
She noted that the U.S. still struggles with prevention, but excels in acute care and medical innovation. “As Americans, we’re not that great at prevention. Our strength has been in the science and application of medicine,” Morgan added.
According to Morgan, the data implies that heart attacks are increasingly survivable compared to 55 years ago—thanks largely to advances in emergency medicine, medications, interventions, and lifesaving devices.
“Today’s physicians are simply better equipped to treat heart attacks than ever before,” she said.
Surviving Heart Attacks May Lead to Long-Term Cardiac Complications
Experts say that while advances in treatment have significantly improved survival rates for heart attacks, many survivors face long-term health consequences that contribute to the rise in other forms of heart disease.
“The non-fatal heart attack often serves as the catalyst for a cascade of chronic cardiovascular conditions, such as heart failure and arrhythmias,” explained Dr. Jayne Morgan, a cardiologist and vice president of medical affairs at Hello Heart.
Dr. Cheng-Han Chen, an interventional cardiologist who was not involved in the study, echoed this, noting that patients who once might have died from a heart attack are now living longer—often with residual damage to the heart muscle.
“The extent of the damage depends on how severe and prolonged the heart attack was,” said Dr. Chen. “This weakening of the heart muscle can eventually lead to heart failure.”
He clarified that heart failure doesn’t mean the heart has stopped functioning entirely. “Heart failure exists on a spectrum,” Chen said. “The heart may not pump as efficiently as it once did—it could be mild or severe, or anywhere in between.”
In many cases, mild heart failure can be managed with medication and may not significantly impair a person’s quality of life. “You can actually live with mild heart failure for the rest of your life,” Chen noted.
Survivors of heart attacks are also living longer than in past decades—a fact that, while positive, has its own implications. Conditions such as heart failure, hypertension-related heart disease, and arrhythmias are all more common with age. As life expectancy increases, so too does the likelihood of developing these chronic cardiac conditions.
Lifestyle and Prevention: The Growing Importance of Heart Health Management
The modern American lifestyle plays a significant role in the nation’s rising rates of heart failure, hypertension, and arrhythmia, according to Dr. Jayne Morgan, a cardiologist and vice president of medical affairs at Hello Heart.
She points to a host of interrelated risk factors that have become all too common:
“Obesity, hypertension, sedentary behavior, highly processed and palatable fast food, smoking, high cholesterol, diabetes, and chronic stress—all contribute to persistent inflammation that compromises cardiovascular health,” Morgan explained.
Socioeconomic barriers can make addressing these risks even more difficult, particularly for women.
“Complications during pregnancy, including hypertensive disorders, preeclampsia, and gestational diabetes, can significantly increase a woman’s lifetime risk of heart disease,” she said. “These conditions remain leading contributors to maternal mortality in the U.S.”
Despite these challenges, the overall decline in heart disease deaths suggests some progress is being made in combatting certain lifestyle-related risk factors. Still, as one area improves, others worsen—particularly in the case of arrhythmias.
Arrhythmia Deaths See Alarming Spike
The new report revealed the sharpest increase in fatalities came from arrhythmias—abnormalities in the heart’s rhythm. These disorders may cause the heart to beat too slowly (bradycardia), too quickly (tachycardia), or irregularly, such as in atrial fibrillation. They are typically classified into four types:
- Bradycardia – slow heart rate
- Tachycardia – fast heart rate
- Ventricular arrhythmia – originates in the heart’s lower chambers
- Supraventricular arrhythmia – originates above the ventricles, such as atrial fibrillation
Many arrhythmias are benign. However, when they interfere with the heart’s ability to pump blood effectively, they can damage the brain, lungs, and other vital organs—and may become life-threatening.
Routine heart-health screenings can help detect arrhythmias early.
“If you can feel your heartbeat without placing a hand on your chest, or experience palpitations, it’s wise to consult a doctor,” Morgan advised. “Early detection can be crucial, especially for those who’ve survived a heart attack.”
Post-heart attack patients are at particular risk.
“Preventing arrhythmias after a myocardial infarction is critical,” Morgan emphasized. “Ventricular arrhythmias, in particular, can be fatal.”
Fortunately, there are several medical interventions that can reduce this risk. These include the “foundational four” medication regimen for managing heart failure with reduced ejection fraction (HFrEF), as well as statins, implantable cardioverter-defibrillators (ICDs), cardiac rehabilitation, sleep apnea management, and comprehensive lifestyle changes.
How to Stay Heart-Healthy: AHA’s Essential Eight
The American Heart Association (AHA) offers a simple yet powerful eight-step framework for improving and maintaining cardiovascular health:
- Eat a heart-healthy diet
- Increase physical activity
- Quit tobacco use
- Get quality sleep
- Maintain a healthy weight
- Control cholesterol levels
- Regulate blood sugar
- Manage blood pressure
These principles are part of the AHA’s Life’s Essential 8™, which also includes guidance for children’s heart health. More information is available on the AHA’s website.
Frequently Asked Questions
Are heart attacks still common in the U.S.?
Yes, heart attacks remain a common medical event. However, advances in prevention and treatment have drastically reduced the number of deaths caused by heart attacks.
Why are heart attack deaths decreasing?
Improved emergency care, widespread use of medications like statins and blood thinners, better public awareness, and healthier lifestyle habits have contributed to lower mortality from heart attacks.
If heart attacks aren’t the leading cause of heart-related deaths anymore, what is?
Deaths from other cardiovascular conditions, such as heart failure, hypertension-related heart disease, and arrhythmias, are increasing and now make up a larger proportion of heart disease-related fatalities.
What causes the increase in heart failure and arrhythmia deaths?
Longer survival after heart attacks often leads to chronic heart conditions. Additionally, factors like aging populations, obesity, hypertension, and lifestyle contribute to the rise in these diseases.
Does this mean heart disease is no longer a major health issue?
No, heart disease remains the leading cause of death in the U.S. While heart attack deaths have declined, other forms of heart disease continue to pose serious health risks.
How can individuals reduce their risk of heart disease?
Maintaining a heart-healthy lifestyle—such as eating well, exercising regularly, managing blood pressure and cholesterol, avoiding tobacco, and controlling diabetes—can significantly lower heart disease risk.
Conclusion
The sharp decline in heart attack deaths over the past five decades marks a major public health achievement, reflecting advancements in medical treatment, emergency response, and patient education. However, this progress reveals a new reality: while more people are surviving heart attacks, many are living longer with chronic cardiac conditions like heart failure, hypertension-related disease, and arrhythmias—now responsible for the majority of heart-related deaths in the U.S.
These shifting trends underscore the need for a broader, more proactive approach to heart health—one that goes beyond acute care to focus on long-term prevention, early detection, and lifestyle modification. As cardiovascular disease continues to evolve, so too must our efforts to address it—through equitable access to care, improved public awareness, and support for healthy living across all stages of life.
