Over the last several months during the pandemic, emergency room physicians have seen a curious phenomenon – far fewer patients presenting with myocardial infarction (MI) and other emergency conditions.
This drop – reported anecdotally over the last several weeks by frontline health care workers, has been noted in various news stories, pre-print journal articles, and reports from 911 operators in various states have also confirmed a precipitous drop in emergency calls.
In a letter to the editor of the New England Journal of Medicine, physicians in the Kaiser Permanente system in the San Francisco Bay Area provide data comparing the number of hospitalizations for MI prior to the first reported case of COVID-19 to those hospitalizations during the COVID-19 period.
The authors wrote “data from 43,017,810 person-weeks from January 1 through April 14, 2020, were evaluated. The weekly rates of hospitalization for acute myocardial infarction decreased by up to 48% during the Covid-19 period. From January 1 through March 3, 2020, a total of 1051 hospitalization events occurred (incidence rate, 4.1 per 100,000 person-weeks), and from April 8 through April 14, 2020, a total of 61 hospitalization events occurred (incidence rate, 2.1 per 100,000 person-weeks) (incidence rate ratio, 0.52; 95% confidence interval [CI], 0.40 to 0.68; P<0.001).”
This shift is particularly interesting given that a significant number of COVID-19 patients present with cardiovascular symptoms, and that the coronavirus is known to disproportionately effect those patients with pre-existing cardiovascular disease, begging the obvious question: what do these statistics tell us about the disease? And why is this happening? Are patients who might otherwise be admitted with MI being admitted as COVID-19 patients instead? Or are patients simply reluctant to come to the hospital and delaying crucial treatment? The latter has caused a number of organizations like the American College of Cardiology and the American Heart Association to sound the alarm and attempt to raise awareness among patients that it is still safe to call 911, and not to delay potentially lifesaving treatments.
While the authors do not offer any explanation for their findings, they note that similar trends have been observed elsewhere including Italy, and Spain.
Solomon MD, McNulty EJ, Rana JS, et al. The Covid-19 Pandemic and the Incidence of Acute Myocardial Infarction [published online ahead of print, 2020 May 19]. N Engl J Med. 2020;10.1056/NEJMc2015630. doi:10.1056/NEJMc2015630