Importance. The COVID-19 pandemic has resulted in a decline in admissions with cardiovascular (CV) emergencies MESHD. The fatal consequences of this are unknown. Objectives - To describe the place and causes of acute CV death MESHD during the COVID-19 pandemic. Design - Retrospective nationwide cohort. Setting - England and Wales. Participants - All adult TRANS ( age TRANS [≥]18 years) acute CV deaths MESHD (n=580,972) between 1st January 2014 and 2nd June 2020. Exposure - The COVID-19 pandemic (defined as from the onset of the first COVID-19 death MESHD in England on 2nd March 2020). Main outcomes - Place (hospital, care home, home) and acute CV events directly contributing to death MESHD as stated on the first part of the Medical Certificate of Cause of Death MESHD. Results - After 2nd March 2020, there were 22,820 acute CV deaths MESHD of which 5.7% related to COVID-19, and an excess acute CV mortality of 1752 (+8%) compared with the expected daily deaths MESHD in the same period. Deaths MESHD in the community accounted for nearly half of all deaths MESHD during this period. Care homes had the greatest increase in excess acute CV deaths MESHD (1065, +40%), followed by deaths MESHD at home (1728, +34%) and in hospital (57, +0%). The most frequent cause of acute CV death MESHD during this period was stroke MESHD stroke HP (8,290, 36.3%), followed by acute coronary syndrome MESHD (ACS) (5,532, 24.2%), heart failure MESHD (5,280, 23.1%), pulmonary embolism MESHD pulmonary embolism HP (2,067, 9.1%) and cardiac arrest HP (1,037, 4.5%). Deep vein thrombosis MESHD had the greatest increase in cause of excess acute CV death MESHD (18, +25%), followed pulmonary embolism MESHD pulmonary embolism HP (340, +19%) and stroke MESHD stroke HP (782, +10%). The greatest cause of excess CV death MESHD in care homes was stroke MESHD stroke HP (700, +48%), compared with cardiac arrest HP (80, +56%) at home, and pulmonary embolism MESHD pulmonary embolism HP (126, +14%) and cardiogenic shock MESHD cardiogenic shock HP (41, +14%) in hospital. Conclusions and relevance - The COVID-19 pandemic has resulted in an inflation in acute CV deaths MESHD above that expected for the time of year, nearly half of which occurred in the community. The most common cause of acute CV death MESHD was stroke MESHD stroke HP followed by acute coronary syndrome MESHD and heart failure MESHD. This is key information to optimise messaging to the public and enable health resource planning.