Study: Death Rate for Mild Heart Attacks Rose During COVID-19 Pandemic

An analysis of data from the National Health Service (NHS) in England indicates that the death rate for patients who experienced a normally lower-risk heart attack rose sharply during the peak of the coronavirus disease 2019 (COVID-19) pandemic, while the death rate for more severe heart attacks fell.

The study also found a notable drop in the number of people arriving at hospitals with a heart attack, with hospitals treating just more than half of the cases they would normally expect to see at its lowest point. Although this number did rebound, the investigators found that they had still not returned to pre-pandemic levels by the time the study period ended on May 22.

For the study, investigators analyzed admission data for 50,689 patients who had a heart attack and were treated at 99 acute NHS hospitals in England over the 14 months prior to March 23, when the United Kingdom began its lockdown in response to COVID-19. According to a press release, the study is the first detailed insight into what happened to patients with heart attacks as the NHS reorganized to address the pandemic.

“The data have given us a very detailed picture of the way patient behavior changed as COVID-19 swept across Europe,” said lead author Jianhua Wu, PhD, in a statement. “It has revealed that although patients were able to get access to high levels of care, the study suggests a lot of very ill people were not seeking emergency treatment and that may have been an unintended consequence of the ‘Stay at Home’ messaging.”

The analysis looked at 2 types of heart attacks, including 17,246 people who had an ST-elevation myocardial infarction (STEMI) heart attack and 33,443 who had a non-STEMI (NSTEMI) heart attack. An NSTEMI heart attack is the most common form and usually happens when there is a partial blockage to 1 of the blood vessels supplying the heart. A STEMI heart attack occurs when there is a complete blockage of a blood vessel carrying oxygen to the heart.

According to the study results, the number of people going to the hospital with an NSTEMI heart attack was down by 49%, whereas patients with STEMI heart attacks were down by 29% compared with what hospitals typically expect to see.

The smallest number of cases was seen on April 19, when the 99 hospitals recorded just 60 heart attack cases. According to a press release, they would normally expect to see approximately 104.

“It was not the case that people were not having heart attacks—they were deciding not to go to the [the] hospital,” said senior author Chris Gale, PhD, in a statement. “Some were undoubtedly heeding the message to stay at home, others might have been afraid of picking up the virus in [a] hospital or were trying to shield because they had other conditions.”

In the month after lockdown began, the investigators found that the proportion of patients with an NSTEMI heart attack who died within a month went from 5.4% to 7.5%, an increase of 39%. It dropped back to 5% over the following 4 weeks.

During the same period, the 30-day mortality figure for patients who had a STEMI heart attack dropped from 10.2% to 7.7%, a 25% reduction. The rate increased slightly to 8.3% over the following 4 weeks. A press release said that although the investigators cannot identify the precise reasons for the fluctuation, they believe it may be linked to a decrease in patients seeking help, particularly among NSTEMI patients who may not display the classic symptoms of a heart attack.

In the statement, Gale said the study shows that emergency cardiac services were able to maintain their effectiveness during the peak of the pandemic. He added, however, that the impact of these findings will be far-reaching.

“There is little doubt that the substantial drop in admissions to hospital with heart attack will have had substantial repercussions on population health outcomes,” Gale said. “People will have died or developed heart failure as a result of not seeking treatment for their heart attack.”

REFERENCE

Having a heart attack during the peak of the pandemic — how the NHS coped [news release]. University of Leeds; August 5, 2020. https://www.leeds.ac.uk/news/article/4644/having_a_heart_attack_during_the_peak_of_the_pandemic-how_the_nhs_coped. Accessed August 10, 2020.