Heart Attacks Are Not the Leading Cause of Sudden Cardiac Death, New Study Finds

A new study reveals that while heart attacks have become far less deadly over the past 50 years, they are no longer the primary cause of heart-related deaths in the United States, prompting a shift in how cardiovascular mortality is understood.

Published in the Journal of the American Heart Association, the research analyzed mortality trends from 1970 to 2022 and found that deaths from acute myocardial infarctions — commonly known as heart attacks — decreased by 89% during that period. This dramatic decline is attributed to advances in emergency care, widespread use of treatments like artery-opening stents and cholesterol-lowering statins, increased bystander CPR, and public health efforts that reduced smoking rates.

As a result of improved survival after heart attacks, more individuals are living longer with damaged hearts, increasing their risk of developing other chronic heart conditions. The study found that deaths from heart failure rose by 81%, hypertension-related heart disease deaths increased by 106%, and fatalities from arrhythmias surged by 450% over the same timeframe.

Despite these shifts, heart disease remains the leading cause of death among Americans. However, its overall mortality has decreased by 66% since 1970. In 1970, ischemic heart disease — which includes heart attacks — accounted for 91% of all heart disease-related deaths. By 2022, that share had fallen to 53%, meaning that nearly half of all heart-related deaths now stem from conditions other than heart attacks.

Dr. Sara King, lead author of the study and a second-year internal medicine resident at Stanford University School of Medicine, emphasized that the findings reflect progress in treating acute cardiac events. “There have been great strides made in helping people survive initial acute cardiac events that were once considered a death sentence,” she said in a statement accompanying the research.

Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver, who was not involved in the study, noted that while dying from a heart attack is now less likely, survivors often face significant long-term disability. “These days, the likelihood of dying from a heart attack is relatively low compared to where it’s been, but the likelihood of significant disability from the heart attack is still high,” Freeman said.

The researchers highlighted that the rise in deaths from chronic heart conditions is, in part, a consequence of success: more people surviving heart attacks go on to develop heart failure, hypertensive heart disease, or arrhythmias over time. “People now are surviving these acute events, so they have the opportunity to develop these other heart conditions,” King explained.

In 1970, 41% of all deaths in the United States were attributed to heart ailments. By 2022, that proportion had declined to 24% of all deaths, reflecting broader improvements in cardiovascular prevention and treatment. Still, experts caution that the growing burden of chronic heart disease requires renewed focus on long-term management, lifestyle interventions, and access to ongoing care for survivors of heart attacks.