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Doctors Say: Don't Sit Out a Heart Attack at Home
Hospitals Worldwide See Significant Drop in Heart Attack Patients Since COVID-19 Pandemic.
Not Getting Treated in Time Means Heart Muscle Dies.
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Twitter Poll by AngioplastyOrg
(Apr 2, 2020)

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Where Have All the Heart Attacks Gone?
-- NY Times
(Apr 6, 2020)

The Mystery of the Missing STEMIs During the COVID-19 Pandemic
(Apr 2, 2020)

Twitter poll showing significant drop in patients presenting with heart attack symptoms (MI/ACS)
Twitter poll showing significant drop in patients presenting with heart attack symptoms (MI/ACS)
April 6, 2020 -- Since the onset of the novel coronavirus COVID-19, hospital emergency departments have seen a precipitous drop in the number of heart attack patients presenting for treatment. The big question is why? Are there really less heart attacks occurring, or are patients staying home, afraid to come to the hospital for fear of contracting the virus? There's good reason to believe that the latter may be the case, and the implications are extremely troubling.

A few days ago, Angioplasty.Org posted an informal poll on our Twitter feed to assess the amount of decrease. The results showed that half of the respondents reported a 40-60% reduction; and, almost a quarter said that the decrease was greater than 60%! This poll was cited earlier today by Dr. Harlan Krumholz in his New York Times article, "Where Have All the Heart Attacks Gone?"

Here's why that statistic is very worrisome: waiting to get treated will result in long-term and irreversible damage to the heart muscle.

Why is Angioplasty for a Heart Attack So Important?
The gold standard for the treatment of the most serious form of heart attack is angioplasty, ideally performed within a couple hours of the onset of symptoms. Called a STEMI (ST-Elevation Myocardial Infarction), this form of heart attack is caused by a sudden closing off of a major coronary artery which supplies blood and oxygen to the heart muscle. Angioplasty, also called PCI (Percutaneous Coronary Intervention), can open the artery and restore blood flow, almost always using a stent. If this can be done quickly, the heart muscle recovers and virtually no damage is done. If not, the heart muscle will die, resulting in heart failure, decreased quality of life, potential future heart attacks, and earlier cardiac death.

What Happens When You Report a Heart Attack?
The American Heart Association estimates that there are currently 720,000 new heart attacks annually in U.S. More than half of those get treated in time with PCI. Over the past decade, cardiology organizations have pioneered the D2B initiative. D2B stands for door-to-balloon time: when a patient presents at the emergency department, the goal is to diagnose his/her heart attack, transport the patient to the catheterization lab, and have a balloon/stent inflated within 90 minutes, thereby saving the heart muscle from damage. This initiative has been widely successful; many hospitals and EMT systems now diagnose the heart attack in the ambulance, and transport the patient directly to the cath lab, cutting D2B times to an hour or less.

Why Do Patients Resist Calling for Help?
A major challenge has been helping patients to recognize the importance of identifying symptoms and calling 911 ASAP. Many people with STEMI symptoms initially feel it's just an upset stomach, or a muscle pain that will go away. Especially in the U.S., where a visit to the Emergency Room can cost an inordinate amount of money, even if one is insured, the tendency to resist a hospital visit is strong. So, with the COVID-19 pandemic overwhelming the healthcare system, patients are understandably hesitant to call an ambulance. They worry that perhaps their symptoms may be a "false alarm" and they don't want to draw resources away from treating those infected with COVID-19, or they are simply afraid of walking through the ER door and being exposed to the virus.

Cardiologists are Focused on COVID Safety
Physicians worldwide are attempting to deliver the message to patients who are experiencing chest pain or symptoms that they should not hesitate to call for help. Call your doctor or call 911 (or in the UK, call 999). Get to a hospital. The healthcare workers in most centers understand the issues and have organized systems so that heart attack patients are kept safe from contamination.

For more information, click on the links in our external links above. For a report from an interventional cardiologist in the UK, check out this video chat from Dr. Rohin Francis:

Reported by Burt Cohen, April 6, 2020