Systematic Review and Meta-Analysis of the Impact of the COVID-19 Pandemic on Heart Failure Rates (2019–2026)

Cardiovascular disease was the leading cause of death worldwide when a novel coronavirus, SARS-CoV-2, began spreading in late 2019, and the collision of these two forces reshaped population cardiovascular health in ways that are still being measured. This dissertation examined whether, how much, and for whom the COVID-19 pandemic altered heart failure (HF) rates between 2019 and 2026. The study employed a dual-track design: a PRISMA 2020-compliant systematic review and random-effects meta-analysis of eligible studies reporting HF outcomes, complemented by a secondary analysis of publicly available aggregate data drawn from seven databases, including the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) Global Health Observatory, Our World in Data, and the Johns Hopkins Center for Systems Science and Engineering. Rather than a single omnibus estimate, the review pursued outcome-specific synthesis and mandatory equity stratification. Meta-analysis of 12 studies encompassing approximately 2.7 million participants yielded a pooled hazard ratio of 1.43 (95% CI: 1.25–1.65) for incident HF following COVID-19, although substantial heterogeneity (I² = 95.0%) produced a 95% prediction interval (0.89–2.31) that crossed the null. Aggregate analyses showed that HF contributed to 7.71% of United States COVID-19 deaths, a proportion that nearly doubled from 7.53% in 2020 to 14.51% in 2023, while heart disease deaths peaked in January 2022 at 71,528, some 21.5% above the pre-pandemic baseline. HF hospitalizations fell 44% during initial lockdowns (pooled RR = 0.56), and global noncommunicable-disease deaths rose 3.1% by 2021. The burden was distributed inequitably: adults aged 85 years and older exhibited 9.12 times the HF-COVID mortality proportion of those aged 0–24, marked geographic dispersion (Gini = 0.188) was observed across states, and pronounced racial and ethnic disparities emerged. The findings indicate a dual burden of elevated HF risk alongside disrupted HF care, with implications for surveillance, research funding, coding practice, clinical integration, and pandemic preparedness at the CDC, the National Institutes of Health, and the WHO.