Vermont’s Cardiac Catastrophe, Part 2A: Heart Failure in Men
con·ges·tive heart fail·ure
noun: congestive heart failure; plural noun: congestive heart failures
a weakness of the heart that leads to a buildup of fluid in the lungs and surrounding body tissues.
Heart failure — sometimes known as congestive heart failure — occurs when the heart muscle doesn’t pump blood as well as it should. When this happens, blood often backs up and fluid can build up in the lungs, causing shortness of breath.
Similar to cardiogenic shock, heart failure is another cardiac condition that has a massive signal for excess mortality throughout the pandemic years – but kills 15-20x as many people as cardiogenic shock.
Heart failure is a bit more complicated to unwind than cardiogenic shock, because heart failures had significant excess mortality in 2020 as well as 2021 and 2022.
With that said, I believe that it is improbable the patterns in heart failure excess mortality in 2021 and 2022 are simply a continuation of the same excess seen in 2020. Rather, the 2021/22 excess heart failures seem to be the product of something else.
The goal of this article is to explain why.
Heart Failure Data
Note: where there is an a/b, chart a = full calendar year & chart b = through 9/30 each year.
Chart #1a/1b: Heart Failure Total
Chart #2a/2b: Heart Failure by Place of Death & Gender
Chart #3: Heart Failure Cumulative Trend
Chart #4: Heart Failure by Cause Designation on Death Certificate
Chart #5a/5b: Heart Failure by Age Cohort
It is undeniable that there has been considerable excess death – in the order of 15-25% excess depending on what you focus on – involving heart failure.
Are the excess heart failure deaths of the pandemic years a clinical or administrative phenomenon?
For much the same reasons as cardiogenic shock, it is dubious that the excess heart failure deaths are merely the result of administrative decisions or shifting conventions regarding assigning CoD’s, so I won’t rehash this here.
What are the specific trends of excess heart failure mortality?
This is the salient query, and a somewhat complicated one to address, because it seems that there are multiple distinct trends of excess mortality associated with heart failures.
Excess Mortality Trends in 2020
Both genders saw significant excess heart failure deaths in 2020:
However, there are several critical differences between the men and women.
This article will focus on the men, and the next one will be about the women.
Background: What does Cause A, B, C, D & Other Contributing Conditions on a death certificate mean?
Below is a screenshot from the official CDC guidance instructing how to fill out a death certificate:
Put simply, what these are *supposed to be* is as follows:
- [Part 1] Cause A = the thing that actually killed the patient
- [Part 1] Cause B/C/D = the clinical chain of conditions that led to Cause A (like a bunch of dominos falling with Cause A being the last one that falls, killing the patient)
- [Part 2] Other Causes = conditions that made the dead fellow more susceptible to whatever pathology is documented in Causes A/B/C/D (“Part 1” of the death certificate)(Note: I often use ‘Part 2’ to refer to ‘Other Causes’ throughout the article)
In practice, these instructions are not always followed. Many if not most doctors who fill out death certificates do not have sufficient training (or time) to accurately document the clinical CoD’s in the officially prescribed manner. (I suspect that some doctors also have a notion along the lines of that Cause A = the direct cause of death; Cause B/C/D = underlying conditions that helped the patient deteriorate; & Other Causes = random underlying comorbidities that predisposed the patient to bad outcomes generally.)
Let us now return to our feature presentation.
Heart Failure – Men
This chart shows the overall trend for all male deaths that list heart failure as a CoD (2022 is only through mid-October, but is outpacing 2021 so far):
Heart failure was a very stable CoD prior to the pandemic, but with the pandemic exploded to the tune of about 25% excess in 2020 & 2021, and a whopping 35% to date in 2022 (!!). This alone is a public health catastrophe, and should raise some urgent questions.
Breakdown by Year, CoD Cause
When we breakdown male heart failures by death certificate Cause, we get the following:
Since the excess is almost entirely in the Other Cause / Part 2 heart failures, we’ll start with those.
Other Cause / Part 2 CoD Heart Failure in Men:
Here’s where the real excess is hiding:
This is a monstrous mortality massacre – 2020 clocks in at about 37.5% excess; 2021 thunders down at about 55% (!); and 2022 is so far 14% above 2021, which projected through the end of 2022 would equal a gobsmacking 76.3% excess above the pre-pandemic average, after considerable excess in both 2020 & 2021!!!
Put differently, before the pandemic, there were an average of 116 deaths/year in decedents who had heart failure listed as an underlying condition, vs 495 such deaths in the 2.8 pandemic years so far – instead of what would’ve been 348 under ‘normal’ circumstances – for an average of 177/year. This is the equivalent of 4.25 years worth of heart failure deaths (!!!), and 2022 is still not finished yet – and will almost certainly eclipse 4.5 years worth by the end of 2022 if not more.
That’s an extra 1.5 years of heart failure deaths so far, over a span of 2.8 years. Extrapolated for the entire US, this would be more than 50,000 EXCESS MALE deaths in just 2021/22 with heart failure listed as a Part 2 contributing CoD – from just ONE condition, only in men, & after substantial heart failure excess mortality in 2020.
The continuing excess here is all the more startling because the pull-forward effect should be enormous, as there should be a limited reserve of heart failure ppl available to die after TWO consecutive years of monstrous excess mortality in a specific cohort of seniors afflicted with heart failure in the first place.
What is a pull-forward effect?
A pull-forward effect is basically the following scenario:
As you can see, this ‘fictional’ pandemic killed 4 of the 10 people who were originally going to die in 2021, leaving 2021 with only 6 expected deaths instead of the original 10. So if in 2021 there are still 10 deaths, then there are really 4 excess deaths. And if there were 14 deaths in 2021, 8 of the 14 would be excess deaths.
Obviously, we cannot prognosticate who specifically is slated to die in any given year like what I did in the imaginary hypothetical scenario; but we can apply the principle. In our context, because heart failure predominantly afflicts seniors, we’re dealing with a narrowly defined cohort from which heart failure deaths can come from – men 65+:
Thus it is reasonable to assume that a large chunk of the excess heart failure deaths in 2020 were people who were going to die in 2021 and 2022 – i.e. these deaths were “pulled forward” in time to happen a year or two earlier than they otherwise would have happened.
Applying the pull forward effect to 2021 – and especially 2022 – is a bit more dicey. There are only so many seniors in Vermont who had some degree of heart failure as a comorbid condition that were “available” to die in the first place, especially older seniors who typically won’t survive long with significant heart failure. After 2020 took a big chunk out of this demographic, there should be fewer seniors with heart failure available to be killed off in 2021 or 2022. Yet, 2021 not only reached the baseline from previous years, not only had excess deaths, but also somehow eclipsed the massive excess of 2020!! So where did all the excess 2021 HF deaths come from?
And even if we grant that there were enough seniors with significant heart failure available to be killed off in 2021, how do we explain 2022, which is so far outpacing 2021 (!!!!).
Alternatively, something else might be replenishing the number of people who develop heart failure – or might be killing seniors with a lesser degree of heart failure who would typically survive at least a few more years – thus replacing the heart failures depleted by the excess deaths in 2020, and then 2021. This would be in stark contrast to covid, which specifically preys upon those who already have comorbidities such as heart failure, not those who don’t – i.e., covid has not been shown to cause new heart failure in any appreciable numbers.
Sorting out what happened year by year
There might be differences between the trends in Part 1 CoD vs Part 2 CoD excess HF deaths, so we’ll first do the Part 2 which has most of the excess.
What’s behind the 2020 excess Part 2 CoD male heart failure deaths?
Unlike the 2020 Part 1 excess HF deaths, the Part 2 excess deaths in 2020 are occurring everywhere:
(Note: totals include other & unknown place of death)
It is highly unlikely that covid caused any of the excess heart failures in 2020, because *NONE* of the 2020 Part 2 heart failure deaths, and only of the 3 Part 1 deaths, listed covid (and only 1 of these 3 covid deaths also had pneumonia). We know how aggressive and liberal the environment was to attribute every death to covid, and there was not any incentive in 2020 to minimize covid calamity.
The 2020 excess looks like it was exclusively the consequence of pandemic policies. Chalk up another win for public health.
What about 2021?
Below is the trendline of Part 2 heart failure deaths by half-month intervals. The top chart is HF deaths that also listed covid, the bottom is all such heart failure deaths:
There are several critical observations here:
- Even if we assume that every heart failure + covid death is a genuinely attributable covid death AND that every one of these deaths represents an excess heart failure death (as opposed to one of the HF deaths that were “supposed” to happen), the vast majority of the excess HF deaths are still NOT attributable to covid. This is illustrated by the red and orange boxes connected with the black lines.
- There are ZERO covid + heart failure deaths in 2021 until February 21, where we find the following 79yo male decedent:
- Cause A: Cardiopulmonary Arrest
- Cause B: Acute hypoxemic Respiratory Failure
- Cause C: COVID-19 Pneumonia
- Other Causes: chronic lymphocytic leukemia, hypogammaglobulinemia, end stage renal disease, coronary artery disease, history of deep venous thrombosis, history of Pulmonary Embolism
This fellow hardly seems like but for covid he had much time left on his clock.
Moreover, there were no covid + heart failure deaths until the winter covid wave had petered out (or rather, sort of diminished instead of petering out, which became the ‘new normal’ post-vaccination campaign):
Although this looks like a death that may well not have occurred at that time without covid, this is hardly a patient who had much time left on his clock.
- The end-of-year December shockwave of heart failure deaths is more than THREE TIMES the pre-pandemic average, and at MOST about 1/5 can be blamed on covid assuming that every death certificate with covid on it anywhere represents a legitimate covid death.
- The timing of the first real wave of excess heart failures in 2021 – the month of February – is pretty much where we would expect a bunch of excess heart failure deaths to be if the vaccines were somehow causing or aggrandizing heart damage that was fatal in the short term (or causing fatal complications in this susceptible cohort via some other pathology).
- The timing of the December heart failure shockwave is in the middle of the 2021 covid apocalypse, but before the climax:
This is not what would be expected if the covid wave was the driving force behind the heart failures – if this was covid, then heart failures should be rising with the climax of the covid deaths, not falling precipitously!!
The excess Part 2 male heart failure deaths in 2021 are mostly driven by hospitals and nursing homes – meaning that these heart failures were in patients too ill to live at home (as opposed to 2022 which as we shall see was dominated by at home deaths):
Overall, 2021 was another heart failure monster mortality massacre, despite what should’ve been a very real pull-forward effect from 2020 that depleted the available pool of people with enough heart failure to push them over the edge.
But if you think 2021 was bad, wait until you see 2022. . .
SADS: Dying at Home Edition
2022 is particularly the year of dying at home for men. Especially those between the ages of 65-84:
The following chart is through 9-30 each year to convey the scale of the 2022 dominance over all prior years:
It makes sense that extra people died at home in 2020 – 2020 was the year of lockdowns and other retarded pandemic policies that were so destructive (as we laid out earlier).
It does not make sense that even more people – as in MORE THAN DOUBLE the pre-pandemic average – would die at home with heart failure in 2022, well after the lockdowns that kept everyone at home were relegated to the dustbin (for now at least). And remember, this is after the massive excess heart failure mortality of 2020 & 2021!!
We can see that the excess people dying at home with cardiac failure in 2022 were NOT the people dying at home with heart failure in 2020 or 2021 – the average age of the at-home heart failure mortality drops precipitously in 2022 compared to 2020 or 2021:
2020 - 84.052 2021 - 83.465 2022 - 81.633
Thus the rocketing number of at-home heart failure deaths in 2022 suggests that there is something clinically or pathologically distinct about the 2022 excess heart failure deaths.
The covid vaccines are for sure a plausible hypothesis to explain this phenomenon.
Breaking down 2022 by age
2022’s dominance is especially pronounced in the 65-80 cohort:
(I apologize for accidentally placing the 50-64 age cohort in between the 86+ & the 65-120 (i.e. all seniors). I first realized after I had already decorated the screenshot, and I was not interested in doing the decorating all over again.)
The 2022 excess seems like it may have hit a ceiling of sorts, because the 86+ cohort – the one that provides the bulk of all deaths – might be maxed out to some degree, since there are only so many people above 85 that can survive with any degree of heart failure, let alone after they were cleaned out during 2020 & 2021.
Otherwise, the other age cohorts of seniors are ALL getting slammed in 2022 well above the baseline from any prior year (except 2020 for the 81-85yo).
The rampant excess in 65-75 yo – a cohort that did not suffer that much excess heart failure death in either 2020 or 2021 – supports the hypothesis I suggested earlier that there is something novel causing new or worsening heart failures in people not otherwise disposed to suffering heart failure severe enough to kill them in the short term.
Clearly, there is disturbing excess heart failure mortality in men not easily explained by covid or pandemic policies.
Part 1 Heart Failure CoD’s
Although almost all of the excess heart failure death in men is in the Part 2 CoD’s, it is nevertheless instructive to see what is going on with the Part 1 CoD’s as well.
Cause A Heart Failure in Men:
We can drill down to find where the excess in 2020 is coming from – it’s entirely seniors dying at home:
There is actually more than twice as many excess HF deaths in male seniors at home as there is excess HF deaths in 2020 altogether – this is probably because some of the deaths that would normally occur in hospitals or nursing homes occurred at home instead.
Notably, there was not ONE Heart Failure Cause A death in men 65+ that listed covid anywhere on the death certificate, indicating that the excess here is almost definitely a result of lockdowns (or other pandemic policies/behavioral shifts).
Cause B/C/D Heart Failure in Men:
Looking at the topline numbers, 2018 was definitely a bad year, and in a vacuum we might just assume there was a bit of excess death.
2019 is a bit odd though, because 2019 saw no excess All Cause Mortality for men in Vermont – and saw a deficit if you exclude Fentanyl deaths that were rising rapidly year over year – yet the Cause B/C/D heart failure deaths were well above the 2015-2017 trend, despite a whopper excess year in 2018 of HF Secondary Cause deaths.
This suggests that in 2018 & 2019 there may have been a shift in how ME’s and/or doctors were assigning CoD’s for Heart Failure, something that may have continued past 2019 into the pandemic years. This is important to keep in mind, because it could be a confounding factor in the pandemic year totals, one not easily accounted for.
Overall, it seems that there was a small amount of excess HF Part 1 mortality in males in 2020 & 2021, and potentially more significant degree of excess in 2022.
There are several important caveats to this analysis that must be stipulated.
Small sample size
Although the signal is large enough that it cannot be written off to random chance, it is way too small to definitively prove anything specific. That notwithstanding, tis jives well with a lot of other evidence and observations about the devastation wrought by the covid vaccines.
Subjective and/or arbitrary nature of death certificates
Overall, the heart failure excess mortality is a powerful, clear and compelling signal that there is something seriously gone awry in 2021 and 2022 that cannot be simply dismissed as the unfortunate consequences of 2020 pandemic polices.
The massive number of excess heart failure deaths in 2021 and 2022 – equivalent to almost a full year of heart failure deaths pre-pandemic – is a shocking phenomenon that nobody can honestly claim to have predicted before the vaccines were rolled out. Trends like these scream out a safety warning that something dire is afoot. Something is behind the nearly 20% excess mortality in Vermont in 2022 to date. . .