Studies point to more heart attacks at home, late ED visits in a pandemic

The incidence of out-of-hospital non-traumatic cardiac arrests in New York City was three times higher during the onset of the COVID-19 pandemic than in the same period last year, according to researchers who published a study late last week. . JAMA Cardiology say points to the need for more effective healthcare in the midst of crises.

The results of a separate study, published today in the US Centers for Disease Control and Prevention (CDC). USA Weekly Morbidity and Mortality Report, highlight the importance of seeking emergency care in the midst of the pandemic, with visits to the emergency department (ED) 23% for heart attack, 20% for stroke and 10% for critically high blood glucose levels from 15 March to May 23 of the previous 10 weeks.

Tripling of cardiac arrests outside the hospital

In the first study, the authors analyzed data from 3,989 patients who had out-of-hospital cardiac arrest requiring resuscitation by New York City 911 Emergency Medical Services from March 1 to April 25, and 1,336 who required the same service in 2019. They found an incidence of out-of-hospital cardiac arrest of 47.5 per 100,000 people during the pandemic, versus 15.9 per 100,000 people in 2019.

Patients who had out-of-hospital cardiac arrest in 2020 were older (mean age, 72 years), compared to 68 years in patients in the comparison period. They were also less likely to be white (20.4% vs. 32.9%) and more likely to have high blood pressure (53.5% vs. 45.7%), diabetes (35.7% vs. 26.0%), and physical limitations (56.6% vs. 47.5 %).

In 2020, the probabilities of asystole (flattening) were higher than in the previous year (odds ratio [OR], 3.50; 95% confidence interval [CI], 2.53 to 4.84; P <.001), as well as the probabilities of electrical activity without pulse (OR, 1.99; 95% CI, 1.31 to 3.02; P= .001).

The pandemic also experienced significant reductions in the return of spontaneous circulation (ROSC) (18.2% vs. 34.7%, P<.001) and sustained ROSC (10.6% vs. 25.2%, P<.001) and a mortality rate greater than 90%.

The authors said they cannot attribute cardiac arrests to COVID-19, but that their data suggests that the high incidence of out-of-hospital events could be the result of vulnerable people delaying care for fear of contracting the virus in a care setting. medical. , lack of access to medical care, or the reluctance of first responders with inadequate personal protective equipment to perform more invasive ventilation procedures that generate virus-containing aerosols.

Fear of infection, lack of medical attention.

In the CDC study, data from CDC’s National Syndromic Surveillance Program showed that since the number of ED visits bottomed out in late March, ED visits for heart attack and stroke have gradually increased, but they are still lower than normal.

The decrease in emergency room visits for high blood sugar levels occurred mainly among people 18 to 44 years old, especially women, while the decrease in heart attack visits was greatest among 65-year-old patients. 74 years old, for both men and women. The largest decrease in stroke visits was among men aged 65 to 74 years and women aged 75 to 84 years.

The largest absolute differences in visits for heart attack and stroke were seen in patients 65 years and older, while adults 18 to 44 years and children had the greatest decrease in visits for high blood sugar levels. .

The researchers said that the decrease in emergency room visits can be attributed to fear of exposure to the new coronavirus, an inability to access medical care, public health recommendations to minimize non-emergency visits or orders from stay at home. They added that the overall decrease in emergency department visits may be at least partially responsible for the abnormally high rate of non-COVID-19-related deaths.

The authors said that anyone with chest pain, loss of motor function, altered mental status, or other serious problems should visit an emergency department immediately, pandemic or not. “Communication from public health and healthcare professionals should reinforce the importance of timely care for acute health conditions and assure the public that EDs are implementing infection prevention and control guidelines to ensure the safety of patients and health care staff, “they wrote.