During COVID-19: Where Did all the heart attacks and strokes go?

Over the last couple of months, I have heard comments from colleagues who work in the hospital asking: ‘Where did all the patients go?’ While there has been a planned reduction in surgeries, elective procedures, and non-urgent admissions to make room for COVID patients, many have also noticed less people coming to hospital for emergencies like heart attacks or strokes.

A recent article in the Journal of the American College of Cardiology looked at data for cardiovascular hospitalizations (heart failure, heart attack, chest pain, stroke) in 2020 compared to 2019, across 15 centers in an integrated tertiary care health care system in USA.

This study found 43% less hospitalizations for cardiovascular conditions in March 2020, compared to March 2019. The daily rate of hospitalizations was stable in January and February 2020, but in March 2020, there was a daily decline in cardiovascular hospitalizations for acute cardiovascular conditions of -5.9% per day. This drop in cardiovascular hospitalizations coincided with a surge in COVID-19 cases, from one single case on March 1, to 6,620 cases on March 31.

So, why would less people be hospitalized for cardiovascular issues during COVID-19?

People may be staying at home with symptoms of heart attack or stroke because they fear coming to hospital.
Decreased consumption of fast food (high salt)
Reduced exposure to air pollution
Telehealth (phone or video) appointments with doctors may be helping to avoid unnecessary non-acute hospitalizations
Less outpatient testing (eg less treadmill tests or other cardiovascular tests which often identify critical heart disease requiring urgent admission to hospital)

The authors and I share the concern that it is highly likely that some people are staying home rather than seeking urgent care, because of the fear of contracting coronavirus if they go to an urgent care center, or possibly because of a misinterpretation of the ‘stay at home’ COVID-19 physical isolation message.

While there are some limitations to this study (which interested readers can read more about here), studies in Europe have shown similar findings.

BOTTOM LINE: It is likely that some people are staying home with symptoms of an acute heart condition or stroke, due to a fear of going to an acute care center that may have COVID-19 patients. I’m writing this blog today to draw attention to this: Don’t avoid or delay care for symptoms that could be a health emergency.

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