Nearly half of on-duty firefighter deaths are related to the heart
Forty-three percent of on-duty firefighter fatalities over the last 35 years were attributed to cardiac causes, according to a new study published in JACC: Advances.[1] These findings call into question the types of screenings firefighters should undergo to detect potential heart problems.
Researchers at Cedars-Sinai Health Sciences University explored autopsy findings from more than 3,000 on-duty firefighter deaths. The group said the proportion of cardiac-related fatalities has steadily increased over the years However, cardiac related deaths have been on the decline for the general U.S. population over the same time period.
These findings might indicate the need to change annual health screenings for firefighters. Current national screening recommendations rely on exercise stress testing, which can identify ischemic issues with blood flow, but may miss hidden structural remodeling of the heart that could lead to sudden cardiac arrest.
“Our research shows there may be a blind spot when it comes to routine heart screenings for firefighters in the U.S.,” senior author Alan Kwan, MD, assistant professor of cardiology in the Smidt Heart Institute at Cedars-Sinai, said in a statement. “Identifying heart conditions when they can be treated is key to addressing these new findings.”
The researchers looked at U.S. Fire Administration records of on-duty firefighter fatalities between 1990-2025. They included firefighters ages 15 to 74 whose deaths were attributed to a sudden "cardiovascular event/heart attack.” They also reviewed National Institute for Occupational Safety and Health Fire Fighter Fatality Investigation and Prevention Program reports, which provide details about line-of-duty fatalities. The group manually applied standardized criteria to adjudicate cardiac verus noncardiac cause of death, and to separate cases into obstructive coronary artery disease (CAD), left ventricular hypertrophy (LVH), and ventricular tachycardia or fibrillation (VT/VF) during events leading to death.
Among 3,401 on-duty fatalities, 1,474 deaths (43%) were attributed to cardiac causes. The mean age of these firefighters was 45.7 years old. Researchers looked at deaths between 1999 through 2019 (2,097) as the primary data pool, because deaths among firefighters increased during the COVID-19 pandemic.
Total firefighter deaths decreased during that time period, but the chance that an on-duty fatality was cardiac-related increased by 2.2% per year. This was more pronounced in career firefighters, who showed an increase by 3.7% per year through 2019. However, there was no significant trend was observed among volunteer firefighters. The research team noted that this difference in trends between career and volunteer firefighters did not reach statistical significance.
While many on-duty firefighter deaths were found to be caused by coronary artery disease, a greater number were connected to enlargement of heart muscle mass that can lead to arrhythmia and sudden cardiac arrest. This is not readily detected by standard exercise stress tests that firefighters undergo as part of their yearly physical. And because firefighters train and workout, they build heart muscle similar to an athlete, but this can mask myocardial changes caused by dangerous heart conditions.
“It’s possible that national firefighter health guidelines need to be updated to include screening for excess heart muscle mass,” study co-author Susan Cheng, MD, MMsc, chair of the department of cardiology at the Smidt Heart Institute, said in the same statement. “It’s not clear why firefighters appear to be at risk for this condition, and so we need to learn more through additional research.”
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]