It provides evidence that people have stayed away from the emergency room even with acute heart attack symptoms. And some may have died as a result.
Researchers from the Providence Heart Institute system based in the US northwest looked at the records of more than 15,000 heart attack patients from between December 30 and May 16 of this year.
And patients with the most serious type of heart attack appeared to be more than twice as likely to die at one point.
There was a substantial decrease in hospitalizations early in the pandemic, with the case rates starting to fall on February 23.
Patients who were hospitalized for a heart attack during the pandemic spent less time at the hospital than before the pandemic. This may be because hospitals wanted to keep beds open in case they were needed for Covid-19 patients, the researchers said. The patients were all seen at hospitals within the Providence St. Joseph Health System in Alaska, California, Montana, Oregon, Texas and Washington.
Patients were also more likely to be sent home from the hospital rather than sent to a rehabilitation center. That may have been out of a concern about the risk of being exposed to the novel coronavirus at those facilities.
The researchers couldn’t find evidence that doctors were treating patients any differently than they would when there wasn’t a pandemic. Yet there was a real difference in how well some patients did.
There was a substantial increase in deaths among patients who suffered a more serious type of heart attack called STEMI. That’s when one of the arteries is blocked and blood and oxygen can’t get to the heart.
The rate of people who died from these serious heart attacks was even greater during the later part of the pandemic, the study found.
“Compared with the before COVID-19 period, however, patients with STEMI had a statistically greater risk of mortality during the later COVID-19 period,” they wrote. One way of analyzing the deaths, called an observed to expected ratio, indicated patients were more than twice as likely to die from STEMI heart attacks during the study period.
Time matters with a serious heart attack. A delay in care due to a patient’s reluctance to seek help or because emergency medical services were behind or the emergency department was full could hurt the chances of survival.
The researchers say more study is needed to determine exactly what contributed to the increased number of deaths.
“If people feel that they might be having symptoms of a heart attack or stroke, then they should call 911, even during the pandemic,” Elkind said.
Elkind, who was not a part of the Providence study, said he would like to know more about why this has been happening.
“Common sense would tell us that many people were afraid to come into the hospital during the pandemic, but there are some other reasons as well,” Elkind said.
In addition to fear, he heard patients say that they didn’t want to be a bother to doctors who are so busy. Elkind is a neurologist at New York Presbyterian Hospital and professor of neurology and epidemiology at Columbia University.
Elkind said there may also have been fewer people having heart attacks.
“This is a little bit more controversial theory,” Elkind said. But with everyone on lockdown, there were fewer cars on the road and less pollution. “We know that air pollution is an important risk factor for heart attacks and strokes. So that could account for some of the same effect. There may have been an actual decrease in incidence of these events.”