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Published on May 05, 2020

Is this a tragic byproduct of COVID-19 fear?

Heart COVID

For the last 23 years, Cape Cod Hospital Interventional Cardiologist Richard Zelman, MD, FACC, has, without fail, treated about 10-12 heart attack patients a month. But, since COVID-19 arrived on the scene, the number has dropped to about two or three in March and April.

Both he and his colleagues around the country (who are seeing a similar drop in heart attack cases since the pandemic quarantine started) are perplexed – and worried.

“The question is whether patients are having fewer heart attacks, which may be part of it, or whether patients are so reluctant to come into the hospital that they are either suffering heart attacks at home and not realizing it, or dying at home,” said Dr. Zelman, who is Chief of Inpatient Cardiology for Cape Cod Healthcare. “We’ve had several people come in very late into heart attacks, who were very ill and in shock, just because they were scared to come in or were unwilling to come in.”

Interventional cardiologists treat patients who are suffering a life-threatening event known as a STEMI – a serious type of heart attack where one of the major arteries to the heart becomes blocked. A recent study done of nine of the largest interventional cardiology Cath Lab units in the country showed that STEMI cases have dropped by about 30 percent since the COVID-19 outbreak in the U.S. started, according to Interventional Cardiologist Thomas Maddox, MD, MSc, FACC, chairman of the American College of Cardiology (ACC) Science and Quality Committee.

The ACC has issued a press release warning of this trend, and has produced a video featuring Dr. Maddox and the ACC concerns.

On Cape Cod, Dr. Zelman and his colleagues at Cape Cod Hospital (CCH) and Falmouth Hospital (FH) are disturbed by the precipitous drop in heart attacks.

“We’ve had patients who have been seeing and speaking with their doctors, but kind of downplaying their symptoms because they were scared to come in or unwilling to come in,” said Dr. Zelman. “And we have patients that have been seen at other institutions where attempts were made to just kind of tide them over for a few months, and they ended up coming in very sick or dying.”

Strokes Down, Too

The number of stroke patients entering hospitals nationwide has also declined over the last couple months, and CCH and FH are seeing similar trends, he said. It has physicians concerned that we have more to worry about than COVID-19.

“We’ve seen that delaying procedures can be more fatal than coronavirus,” he said. “There’s a lot of data now throughout the country showing that death rates have been significantly higher than what should be attributable to just COVID, alone.

“Initially the thought was, well maybe patients are just having fewer heart attacks because they’re not working or going out to restaurants and eating poorly or not exercising and being more sedentary – and that may be part of it. But, now that we see the numbers showing a very high mortality rate of patients at home, and not necessarily from COVID, it’s becoming clear that the number of patients dying of heart attacks and strokes at home is probably higher.”

Dire Consequences

Waiting too long before seeking care for heart attack or stroke symptoms can have life-threatening or life-altering results.

“One of the things we’ve proven over time is that the mortality of a heart attack or stroke goes up dramatically with every hour that you wait to come in, as opposed to many other illnesses,” Dr. Zelman said.

The long-term damage, if you survive a heart attack, is that the heart muscle would be permanently weakened, and you would be more likely to suffer severe problems that would affect your quality of life, he said. You could develop heart failure or heart rhythm problems. Waiting too long to seek treatment for a stroke could result in permanent brain damage and lasting disability.

“So, even if you survive your heart attack (or stroke), you’re going to be significantly more debilitated from it than you would be if you came in promptly,” he said.

Ironically, for those worried about spending time in a hospital during COVID-19, putting off treatment will likely result in a longer hospital stay, according to Dr. Zelman. The typical stay for an angioplasty (interventional cardiology) procedure, if you come in early enough, is one or two days. If you come in late and end up with multiple problems that could have been avoided, you will likely be in the hospital three or four times as long, he said.

“You also could end up having to go to a rehab or nursing facility, as opposed to being home in 24 hours,” he added.

Hospitals Have Enough Resources

Another possible explanation to the drop in the number of heart attack and stroke cases could be that people are putting off their own health needs in order to allow healthcare workers to concentrate on COVID-19 patients, said Dr. Zelman.

“Many people may just be trying to be good citizens and not use resources that may be needed elsewhere. But by being good citizens, they’re putting themselves at much more risk of personal harm,” he said.

Both CCH and FH are fully prepared and able to care for all patients who need medical treatment, he said. The hospitals now have the ability to test patients for COVID-19 in-house, which means the test results are received in a couple hours, he said. This allows doctors to sequester patients who are exhibiting coronavirus symptoms away from other patients.

“Patients don’t have to worry when they come in to the emergency room or wherever they enter the hospital, that they will be inter-mingled, because we now have adequate testing,” he said. “We, as a healthcare system are very capable of caring for patients in this environment.”