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Journal of Clinical Cardiology

ISSN: 2694-5088

Original Research Open Access

In-hospital Mortality Trends Across the Pre-pandemic, Pandemic, and Post-pandemic Eras in Cardiovascular and Cerebrovascular Conditions: A Retrospective Cohort Study

Swatam Jain1,*, Pinak Shah1, Alfred Danielian2, Boone Singtong1, Christopher Aboujaoude1, Zade Zahlan1, Rakahn Haddadin1, Kush Kapadia1
  • 1Department of Internal Medicine HCA, Mountain View Hospital, Las Vegas, NV, USA
  • 2Department of Cardiovascular Medicine HCA, Mountain View Hospital, Las Vegas NV, USA
+ Affiliations - Affiliations

Corresponding Author

Swatam Jain, Swatamj@gmail.com

Received Date: July 03, 2025

Accepted Date: July 21, 2025

Citation:

Jain S, Shah P, Danielian A, Singtong B, Aboujoude C, Zahlan Z, et al. In-hospital Mortality Trends Across the Prepandemic, Pandemic, and Post-pandemic Eras in Cardiovascular and Cerebrovascular Conditions: A Retrospective Cohort Study. J Clin Cardiol. 2025;6(2):97–102.


Copyright: © 2025 Jain S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background: The COVID-19 pandemic strained healthcare delivery, but its lasting impact on acute and chronic cardiovascular and cerebrovascular mortality remains unclear. We compared in-hospital mortality for ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), ischemic stroke, and congestive heart failure (CHF) across pre-pandemic, pandemic, and post-pandemic eras.

Methods: We performed a retrospective cohort study of 38,735 U.S. hospital admissions (Jan 1, 2019–May 31, 2024) classified as pre-pandemic (Jan 2019–Mar 2020), pandemic (Mar 2020–May 2023), or post-pandemic (May 2023–May 2024). Cases were identified using ICD-10 codes. Multivariable logistic regression—adjusted for age, sex, race, diabetes, hypertension, chronic kidney disease, end-stage renal disease, COPD, and acute COVID-19 infection—assessed mortality odds across eras for each condition.

Results: STEMI (n=6,798) and stroke (n=18,142) mortality did not differ significantly across eras. NSTEMI (n=11,684) and CHF (n=8,775) mortality peaked during the pandemic (NSTEMI OR 1.47; CHF OR 1.53 vs post-pandemic; p<0.05) and declined markedly afterward. Chronic kidney disease (OR 1.41–1.75), end-stage renal disease (OR 2.28–3.40), and acute COVID-19 infection (OR 2.18–2.71) were independent predictors of higher mortality.

Conclusions: STEMI and stroke mortality remained stable across all three eras—likely due to established "code STEMI" and "code stroke" protocols. NSTEMI and CHF mortality peaked during the pandemic and improved post-pandemic, potentially reflecting better resourcing, enhanced care delivery, and widespread implementation of guideline-directed medical therapy. Sustained chronic disease management and emergency protocols are essential to optimize outcomes during and after healthcare crises.

Keywords

Heart failure, Non-ST elevated MI, Ischemic stroke, In-hospital mortality, COVID pandemic

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In-hospital Mortality Trends Across the Pre-pandemic, Pandemic, and Post-pandemic Eras in Cardiovascular and Cerebrovascular Conditions: A Retrospective Cohort Study

The COVID-19 pandemic strained healthcare delivery, but its lasting impact on acute and chronic cardiovascular and cerebrovascular mortality remains unclear. We compared in-hospital mortality for ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), ischemic stroke, and congestive heart failure (CHF) across pre-pandemic, pandemic, and post-pandemic eras.

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