Cardiovascular Care Disruptions Among U.S. Adults During the COVID-19 Pandemic: Medication Use, Mortality, and Medicare Hospitalization Trends From the Behavioral Risk Factor Surveillance System (BRFSS) Database

Abstract

Background Cardiovascular diseases (CVDs) are the leading cause of death in the United States, with mortality disproportionately affecting older adults and racial/ethnic minorities. This study analyzes national patterns in CVD medication use, mortality, and hospitalization from 2019 to 2021. Objectives To examine patterns of antihypertensive and lipid-lowering medication use, trends in CVD-related mortality (stroke, coronary heart disease, and total heart disease), and hospitalization rates for heart failure among the U.S. population before and during the COVID-19 pandemic. Methods This retrospective study utilized Behavioral Risk Factor Surveillance System (BRFSS) data from 2019 to 2021, a nationally representative telephone survey coordinated by the CDC. Trends in cardiovascular medication use were stratified by sex, age, and race/ethnicity. Descriptive statistics, paired t-tests, and one-way ANOVA were used to assess temporal changes. A p-value <0.05 indicates statistical significance. Analyses were conducted using SPSS version 30 (IBM Corp., Armonk, USA). Results The use of antihypertensive and cholesterol-lowering medications remained stable overall but declined slightly in some subgroups during 2020. Among adults with high blood pressure, antihypertensive medication use increased from 57.7% (95% CI: 57.1-58.4) in 2019 to 60.4% (95% CI: 59.6-61.1) in 2021. Similarly, cholesterol-lowering medication use rose from 28.9% (95% CI: 28.6-29.2) to 31.0% (95% CI: 30.6-31.3). Heart failure hospitalizations among Medicare beneficiaries aged ≥65 years declined from 27.72 per 1,000 (95% CI: 27.66-27.78) in 2019 to 22.87 (95% CI: 22.81-22.92) in 2020, before increasing to 25.91 (95% CI: 25.85-25.97) in 2021. Cerebrovascular, coronary heart disease, and overall heart disease mortality rates consistently increased from 2019 to 2021, with heart disease deaths rising from 161.5 to 173.8 per 100,000, totaling over 695,000 deaths in 2021. Conclusions The COVID-19 pandemic was associated with modest declines in CVD medication use and significant increases in cardiovascular mortality, particularly among high-risk populations. Hospitalizations for heart failure initially decreased but partially recovered by 2021. These findings underscore the necessity for resilient healthcare systems and targeted strategies to mitigate pandemic-related disruptions in chronic cardiovascular care.

Keywords: brfss database; cardiovascular disease; hospitalization; medication use; mortality trends.