Out-of-hospital heart attack deaths spiked during pandemic

"Early in the pandemic, people were appropriately advised to stay at home," says Adam Oostema. "Unfortunately, some people may have taken this too far by failing to seek necessary medical attention."(Credit: Duncan c/Flickr)

While COVID-19 has claimed more than 13,000 lives in Michigan, many more likely died from cardiac arrest directly and indirectly attributable to the pandemic, researchers report.

A new study examined out-of-hospital cardiac arrest records in Wayne, Oakland, and Macomb counties from March 23 through May 31, 2020. Researchers compared those records to data for the same period in 2019 and found that the number of cardiac arrests that occurred outside of hospitals soared to 1,854 during the early months of the pandemic, a 60% increase over the same period the year before.

Deaths from cardiac arrest also increased to 1,400 cases, a 42% jump from the previous year.

The increase in cardiac arrests and deaths due to cardiac arrests likely is attributable to several factors, both directly and indirectly related to COVID-19, says J. Adam Oostema, an associate professor of emergency medicine in the Michigan State University College of Human Medicine and coauthor of the paper in JAMA Network Open.

‘Don’t die of doubt’

Oostema worked with coauthors from the state Department of Health and Human Services to analyze cardiac arrest data from the Emergency Services Information System.

“Early in the pandemic, people were appropriately advised to stay at home,” Oostema says. “Unfortunately, some people may have taken this too far by failing to seek necessary medical attention.”

Out of fear of contracting COVID-19, or concern for overwhelming hospitals, some patients likely delayed routine primary care or waited too long to seek emergency help when they experienced symptoms of a heart attack, Oostema says.

To combat this behavior, the American Heart Association started a public service campaign—”Don’t Die of Doubt”—urging people not to delay calling 911 at the first sign of a heart attack or stroke, says coauthor Mathew Reeves, professor of epidemiology and biostatistics.

Joneigh Khaldun, chief medical executive and chief deputy for health at the Michigan Department of Health and Human Services, stresses that Michiganders should always seek help in a medical emergency.

“It is incredibly important that people not delay care, especially if they are having concerning symptoms like chest pain, difficulty breathing, or dizziness,” Khaldun says. “Hospitals and EMS providers are working hard to keep patients safe, so please contact them if you are having a medical emergency.”

COVID-19 and cardiac arrest

Some of the deaths might have been due to changes in treatment protocols for paramedics. Because of the risk of spreading COVID-19 through resuscitation, intubation, and prolonged resuscitation attempts by paramedics were discouraged.

Patients suffering cardiac arrest during the 2020 study period were 53% less likely to be intubated and nearly 10% less likely to receive any attempt at resuscitation compared with the previous year, the researcher found.

COVID-19 likely was a direct cause of cardiac arrest among many patients, particularly those whose conditions deteriorated rapidly, the researchers suggest. They note that the rise in cardiac arrests closely paralleled the spike in COVID-19 cases last spring. “Several signals in the data suggest these were directly COVID-related,” Reeves says.

A disproportionate number of the cases and deaths were among patients 85 years or older (18%), residents of nursing facilities (22%), and African Americans (39%), all populations known to be at higher risk of death from COVID-19. Reports from Italy, France, and New York City have documented similar increases in out-of-hospital cardiac arrests during the pandemic.

The lesson, Oostema says, is that, even during a pandemic, “seeking emergency care is an important thing to do.”

“People should not delay in calling 911 if they think there’s a reason to be concerned,” Reeves says.

Source: Michigan State University