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

BackgroundThe 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. MethodsWe 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. ResultsSTEMI (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. ConclusionsSTEMI 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.