“The number of people who would have routinely come in for heart attacks has dwindled,” says Ravi Hira, MD, an interventional cardiologist with UW Medicine and associate professor of medicine at the University of Washington in Seattle. “We believe people are still suffering from the same heart issues; they’re just choosing to not come in, either because of the fear of acquiring coronavirus in the hospital or that they would be taking a bed away from someone else who might need it more.” This trend has been documented in other countries that have been hit hard by the coronavirus, such as Spain and Italy, says Erin Michos, MD, a cardiologist and the director of women’s cardiovascular health at Johns Hopkins Medicine in Baltimore. “Those countries saw the number of interventions for serious heart attacks decline by about 40 percent,” she says. “Although it would be nice to think we’re not having as many heart attacks due to people being home more, less air pollution, and fewer stressful commutes to work, I am skeptical that that’s the case,” says Dr. Michos. “Stress levels are still high, which can contribute to the likelihood of a heart attack. We’re worried that because patients are so scared about being exposed to COVID-19 that they might be ignoring or suffering through acute heart symptoms at home.”
Heart Attack Patients Need to Seek Immediate Care
There has been an uptick in mortality and deaths at home in New York City, and part of that is likely related to COVID-19, says Dr. Hira. In the first five days of April, 1,125 people were pronounced dead in their homes or on the street in New York City, more than 8 times the number of deaths for the same time period in 2019, according to an article in The New York Times. “I suspect a substantial portion of that is patients who normally would have gone to the emergency room or called 911 and instead chose not to do so and subsequently died from their emergent or acute issue at home,” Hira says. “Folks watching the news can have the impression that the hospitals are full of COVID-19 patients and they don’t want to take that risk.” Heart attacks are caused by a clot in the heart arteries that blocks blood flow to the heart muscle, says Hira. “If that tissue doesn’t get blood flow back to it, that tissue is going to die, and that’s what a heart attack essentially is — it’s death of the heart cells and heart tissue,” he explains. “The risks and problems of not coming to the hospital to get that treated right away either with medications, a stent, or bypass surgery is that heart tissue that dies is not going to come back,” Hira says. “It’s not going to recover or grow new tissue, and that can lead to a host of problems down the road. These issues can include a weakened heart or heart failure and abnormal heart rhythms caused by the scar tissue that forms; those abnormal heart rhythms can also lead to death.” There is a lot of concern that patients are sitting at home and suffering and are going to come in with these late presentations or die at home, says Hira. “If you seek care early, we can actually intervene to impact things for a more positive outcome and avoid worse issues and death down the road,” he says.
People With a Heart Condition Are at an Increased Risk of Complications From COVID-19
“When I talk to my patients over the phone — because most of our visits are over the phone now — they are really, really afraid of going out because their disease and their age puts them at high risk for complications or death from COVID-19,” says Hira. People with underlying medical conditions, including serious heart conditions, can be at an increased risk for catching a more severe case of COVID-19, according to the CDC. Hira recounts recent phone calls with two patients who were having active symptoms. “One was willing to come in for a visit and was admitted to the hospital, but I could not convince the other patient to come in for testing. He said, ‘I know I’m too high risk. I’m having symptoms but I would rather die at home than go to the hospital and risk getting COVID-19,’” says Hira. A phenomenon called anchoring bias may also be contributing to why people are staying home, says Jennifer Lewey, MD, a cardiologist and the director of Penn Women’s Cardiovascular Health Program in Philadelphia. Anchoring bias is when a person relies too heavily on an initial piece of information when making a decision and tends to focus too much on that and not enough on other information. “The focus right now is on COVID-19, so even if they’re having heart attack symptoms, they’re often not even thinking that it could be heart disease. All they are thinking is this has to be COVID-19,” says Dr. Lewey.
Women Are More Likely to Stay at Home During a Heart Attack
Even outside the pandemic, data shows that women are less likely to call 911 and seek care if they think they’re having a heart attack, according to Lewey. “I think part of that is that they don’t recognize the symptoms because they tend to be less typical, but part of that also is that they don’t want to bother or inconvenience anyone,” she says. The impact of COVID-19 on women seeking care for a heart attack is twofold, says Lewey. “One is that some of the symptoms of COVID-19 include shortness of breath, which can also be a presenting sign of a heart attack, especially in women. I also believe that if there was a predisposition to not ask for help prior to COVID-19, then that may be exacerbated now,” she says.
If You Think You Are Having a Heart Attack, Call Your Doctor or 911
“I tell my patients if what you experience would be considered an emergency three months ago before the pandemic began, then you should still do those same things: Call 911 or go to the ER if the situation calls for it. An emergency is still an emergency,” says Hira. “If a patient is having crushing chest pain that is basically suggestive of a heart attack, then they should do exactly what they would have done in the past.” The same goes for any other medical issues that a person might have that would bring them to the emergency room, adds Hira. “If you’re having a stroke and you can’t lift your arm, that’s still a stroke and you need immediate care. It doesn’t matter that a pandemic is going on outside,” he says. And there’s nothing to stop you from calling your doctor, says Hira, noting, “You may not be able to see them in person, but you’ll get ahold of them by phone or video conference, and at least they can address your issue.” He also makes the point that “people are here at the hospital and clinics to help. The pandemic has many providers busy taking care of those patients, but that doesn’t mean that they don’t want to take care of you.” Nothing has changed on the part of healthcare providers when it comes to taking care of heart attack patients other than the protective gear that they wear, he adds. It’s important to take note of the healthcare disparities related to the COVID-19 pandemic, says Lewey. “We know that underrepresented minorities such as black or Hispanic individuals are more likely to have cardiovascular risk factors, are more likely to have cardiac disease, and therefore are more likely to have worse outcomes,” she says. It’s especially important for those individuals to maintain contact with their healthcare providers, and that goes for women as well, says Lewey. “Women tend to be caretakers more,” she says. “Right now, many of them may be working from home, taking care of the kids who are home from school, and even taking care of family members who may be sick — all of which makes them especially vulnerable.”
