Cardiac Deaths Rise to 43% of On-Duty Firefighter Fatalities Despite Overall Safety Gains
Observational record review shows cardiac causes now dominate on-duty firefighter deaths and are rising. Standard stress testing misses hypertrophy; structural imaging may be needed. Evidence is limited by autopsy availability and lack of controls.
Investigators from Cedars-Sinai analyzed U.S. Fire Administration records and autopsy data in the JACC: Advances study. They documented coronary artery disease in many cases but identified left ventricular hypertrophy and other myocardial enlargement patterns in a larger share—conditions poorly captured by annual exercise stress testing required under current NFPA guidelines. Athletic remodeling from intense training may mask pathological changes, creating a detection gap.
Kwan et al.: Within 36 months, at least one major U.S. fire department will adopt echocardiography in annual physicals and report a 15% drop in on-duty cardiac events compared with matched departments using stress testing alone.
Sources (3)
- [1]Primary Source(https://doi.org/10.1016/j.jacadv.2026.103383)
- [2]Supporting Source(https://www.nfpa.org/-/media/Files/News-and-Research/Fire-statistics-and-reports/Emergency-responders/osfirefighterfatalities.pdf)
- [3]Supporting Source(https://www.cdc.gov/niosh/firefighters/pdfs/Heart-Disease-in-Firefighters-508.pdf)