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The #COVID19 pandemic has been devastating, but clinicians have also worried about the indirect toll of the pandemic on patients
Our new @SmithBIDMC study in @JACCJournals examines cardiovascular deaths during the early US pandemic
https://bit.ly/2K5lRHn (THREAD)
Our new @SmithBIDMC study in @JACCJournals examines cardiovascular deaths during the early US pandemic
https://bit.ly/2K5lRHn (THREAD)
We evaluated changes in CV deaths during the first few months of the pandemic in 2020, compared w/ changes in 2019
Overall, we observed
deaths due to ischemic heart disease (relative change +11%) & hypertensive diseases (17%) in the US, but no change for other conditions 2/
Overall, we observed
deaths due to ischemic heart disease (relative change +11%) & hypertensive diseases (17%) in the US, but no change for other conditions 2/
These primarily occurred in areas that experienced the initial surge of #covid19 cases
In NYC, deaths due to ischemic heart disease 2-fold. New Jersey, Michigan, and Illinois also experienced deaths due to ischemic heart & hypertensive diseases. 3/
primarily occurred in areas that experienced the initial surge of #covid19 casesIn NYC, deaths due to ischemic heart disease
2-fold. New Jersey, Michigan, and Illinois also experienced deaths due to ischemic heart & hypertensive diseases. 3/
In contrast, cardiovascular deaths *did not* increase during in some states that were hit hard during the early pandemic, like Massachusetts.
Potential explanations highlighted in this excellent @WBUR piece by @goldbergcarey
https://www.wbur.org/commonhealth/2021/01/11/heart-attack-deaths-mass-coronavirus
4/
Potential explanations highlighted in this excellent @WBUR piece by @goldbergcarey
https://www.wbur.org/commonhealth/2021/01/11/heart-attack-deaths-mass-coronavirus
4/
Why did heart-related deaths in some regions of the U.S.?
During the early phase of the pandemic, there was a big
in hospitalizations for urgent heart conditions
"Where did all the heart attacks go?" 5/ http://nyti.ms/3btpfqQ
in some regions of the U.S.?During the early phase of the pandemic, there was a big
in hospitalizations for urgent heart conditions "Where did all the heart attacks go?" 5/ http://nyti.ms/3btpfqQ
Patients with urgent heart conditions may have avoided necessary care, due to fear of exposure to #Covid19 in hospitals, and died at home
A clear spike in deaths-at-home was documented during the early pandemic in #NYC 6/
A clear spike in deaths-at-home was documented during the early pandemic in #NYC 6/
Health care systems were also overwhelmed, and patients w/ urgent medical conditions may have faced challenges in accessing timely care.
We're hearing stories like this now emerge from LA county. 7/ http://lat.ms/3bAZaGB
We're hearing stories like this now emerge from LA county. 7/ http://lat.ms/3bAZaGB
Other factors, including longer EMS response times, bystander CPR rates, & delays in semi-elective cardiac procedures (e.g. TAVR) may have also contributed 8/
https://ja.ma/3br1hN3
https://www.jacc.org/doi/full/10.1016/j.jacep.2020.08.010
bystander CPR rates, & delays in semi-elective cardiac procedures (e.g. TAVR) may have also contributed 8/https://ja.ma/3br1hN3
https://www.jacc.org/doi/full/10.1016/j.jacep.2020.08.010
A proportion of these deaths undoubtedly represent complications of *undiagnosed* #COVID19
Is this a lock-down effect? Unlikely. States w/ fewer cases that implemented stay-at-home orders did not have an CV deaths. High-burden areas did, perhaps d/t fear+ hospital strain 9/
Is this a lock-down effect? Unlikely. States w/ fewer cases that implemented stay-at-home orders did not have an
CV deaths. High-burden areas did, perhaps d/t fear+ hospital strain 9/
Overall, our findings parallel a U.K. study, which also observed an abrupt cardiovascular deaths during their surge of #covid19 cases. @mmamas1973 10/ https://heart.bmj.com/content/107/2/113.abstract
cardiovascular deaths during their surge of #covid19 cases. @mmamas1973 10/ https://heart.bmj.com/content/107/2/113.abstract
We can't quantify the extent to which hospital avoidance, health care system strain, deferred procedural care, and/or undiagnosed #covid19, contributed to the in heart disease & hypertensive deaths.
Nonetheless, the public health implications are clear... 11/
in heart disease & hypertensive deaths.Nonetheless, the public health implications are clear... 11/
It's *critically important* that state health depts. & public health leaders continue to encourage patients with worrisome symptoms to seek medical care.
Hospitals are safe environments to receive medical care, even in amid this public health crisis. 11/ https://bit.ly/3oA9MJb
Hospitals are safe environments to receive medical care, even in amid this public health crisis. 11/ https://bit.ly/3oA9MJb
The indirect toll of the pandemic - on top of the devastating direct toll of #covid19 - only reinforces how impt. it is that we collectively adhere to public health measures (wear masks, socially distance) & intensify vaccination efforts, to bring this pandemic to an end /Fin
