Barely a month ago – hey, remember a month ago? – my GP ordered a number of routine blood and urine tests following a meds review. So I booked an appointment online at my local testing lab – but within hours, I decided to cancel. All I could think about was this: “Lab waiting rooms are filled with sick people!” There was no way I was going to put myself at further risk during this COVID-19 pandemic.
It turns out that heart patients like me are not only reluctant to walk into lab waiting rooms, but cardiologists are now reporting that many of us are reluctant to seek urgent medical care – even during a heart attack. . .
In his New York Times essay called “Where Have All the Heart Attacks Gone?“, Yale University cardiologist Dr. Harlan Krumholz cited a study from Spain that found a 40 per cent reduction in procedures for heart attacks during the last week of March compared with just before the pandemic hit.
Other countries are reporting similar results. In a new study of nine high-volume cardiac centres across the U.S. published on Friday in the Journal of the American College of Cardiology, procedures to treat serious STEMI heart attacks dropped by 38 per cent after March 1, 2020 compared with the 14 previous months.(1)
These findings don’t seem to make sense. What has happened to all the heart patients?
As Dr. Krumholz explained, he and his colleagues actually expected to see more cardiac procedures – not fewer – during this time, because respiratory infections typically increase heart attack risk. He added:
“The most concerning possible explanation is that people stay home and suffer rather than risk coming to the hospital and getting infected with the corona virus.
“This theory suggests that COVID-19 has instilled fear of face-to-face medical care. As a result, many people with urgent health problems like cardiovascular disease may be opting to remain at home, rather than call for help. And when they do finally seek medical attention, it is often only after their condition has worsened.
“We need to combat perceptions that everyone else must stay away from the hospital. The pandemic toll will be much worse if it leads people to avoid care for life-threatening yet treatable conditions like heart attacks and strokes.”
In the U.K., cardiologist Dr. Rohin Francis observed in this video presentation that “everywhere – here, Spain, America, Italy – heart attacks appear to have gone out of fashion.”
He reminds us that, in cardiology, time is muscle:
“In a heart attack, when an artery supplying the heart muscle is blocked, it needs to be unblocked as soon as possible to minimize the amount of permanent damage to that muscle.
“Complications caused by an untreated heart attack are thankfully quite rare these days.
“But this may be changing. Heart patients are now scared of coming to the hospital for fear of catching the COVID-19 virus. Some patients may also be feeling that they don’t want to trouble those hard-working doctors and nurses, who are all so busy treating COVID-19 patients. So they don’t call an ambulance. But 24-48 hours later, they’ve become progressively unwell, and the damage is done.
“Perhaps those of us working in the hospital are not even hearing about the majority suffering in silence, going on to develop heart failure, or even dying at home.”
This is the tragic scenario described by the Fire Department of New York (FDNY). The FDNY runs New York City’s paramedic response through its Emergency Medical Services, and reported this week that on Sunday, April 5, out of 322 cardiac calls to 911 on that day, 241 (almost 75 per cent) ended in sudden cardiac death. That compares with 38 per cent for the same period one year ago. As one senior FDNY officer observed:
“I know crews that go from cardiac arrest to cardiac arrest all day long.”
What this means, he added, is that more heart patients are calling 911 closer to death, and more of them are now dying before they ever reach a hospital.
These findings also reflect what I am hearing from my Heart Sisters blog readers. For example:
♥ “Fear of heart issues was already anxiety-producing, and now fear of COVID-19 is added in. I live in California, one of the worst areas. Extremely scary to think of going to the hospital.”
♥ “Last night, I woke up in the middle of the night with a lot of chest pain. But my biggest fear is having to go to Emergency.”
♥ “I had a STEMI (heart attack) two years ago. Right now, I have been having mid-back pain radiating around to underneath my ribs for two days. But I’m too afraid to go to the E.R.”
♥ “I have to go in for an additional lead for my ICD (Implantable Cardioverter-Defibrillator) and am very nervous to do so. My doctors tell me this is necessary surgery, and assure me that they have safe procedures in place to do it. But this is a very scary time.”
Dr. Rohin Francis warns:
“Just because COVID-19 is dominating the headlines, it doesn’t mean that other medical problems have gone away. Please do NOT ignore serious symptoms, and please do NOT feel you will be adding to our workload. This is what we’re here for!”
Here in Canada, that advice is echoed in the “Emergencies Are Still Emergencies” awareness campaign from the Heart and Stroke Foundation, where Dr. Thalia Field urges people with symptoms of heart attack, cardiac arrest or stroke to seek immediate medical care.
Drs. Amol Verma and Fahad Razak are internal medicine specialists and assistant professors at the University of Toronto, and are also concerned that people who really need hospital care are staying home. They point out in a recent Healthy Debate essay that empty hospital beds for non-virus patients (and the dangerous spikes in serious complications and death caused by associated treatment delays) were similarly problematic during previous viral outbreaks like SARS and Ebola:
“People who have concerning medical issues must not avoid health care. This is an important public health message that has not been communicated widely. People should not confuse ‘social distancing’ and calls to ‘stay home’ as messages to stay away from necessary care.”
And as Philadelphia emergency physician Dr. M. Kit Delgado urged on Twitter:
Our messaging needs to be clear: “Stay home if you are well, come in if you feel sick.”
In short, YOU KNOW YOUR BODY. You know when something is just not right. If you are experiencing symptoms that you suspect are heart-related, please seek immediate medical help.
1. Garcia S, Albaghdadi MS, Meraj PM, et al. “Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic.” J Am Coll Cardiol. 2020; e-pub ahead of print.
Q: Have you hesitated before seeking urgent help for cardiac symptoms? If so, why?
NOTE FROM CAROLYN: I wrote much more about how heart patients can manage health crises in my book, A Woman’s Guide to Living with Heart Disease. You can ask for it at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press. (Spring Book Sale: Use their code HTRY to save 30% off the list price).
♥–CardioSmart (a report from the American College of Cardiology on how COVID-19 affects heart patients)