Ischaemic heart disease

Cardiovascular emergency presentations down during pandemic

The number of people presenting to emergency departments (ED) because of chest pain or stroke symptoms has been lower during the COVID-19 pandemic compared to the pre-pandemic era, a NSW study has found.

A comparison of ED presentations at four hospitals in the Western Sydney Local Health District found significant reductions for several conditions between 29 March – 31 May for 2019 and 2020.

The EDs, with a capacity of 1925 beds and serving a catchment of almost a million people, saw lower numbers of presentations with stroke or intracerebral haemorrhage (ICH), chest pain, infectious enteric disease, pneumonia, and wrist or hand fractures in 2020 than in 2019.

There were four fewer chest pain presentations per day and one less stroke/ICH presentation per day during the pandemic period compared to the previous year.

There was no change numbers of presentations with ACS or transient ischaemic attack. Similarly there was no significant reduction in numbers of ED presentations for other conditions such as malignancy, appendicitis and cholecystitis/cholangitis.

However there was an increase in presentation for mental health problems.

Writing in the MJA, the report authors said lower numbers of presentations with chest pain or stroke had also been reported overseas and may reflect factors other than lower incidence, such as suspension of outpatient clinics and elective procedures, social distancing measures, and public anxiety.

“We found concerning reductions in ED presentation numbers that may indicate delayed seeking of appropriate medical attention,” they said.

“Public health messages should encourage timely presentation of people with time‐sensitive, potentially life‐threatening conditions, even during pandemics.”

Studies of patients presenting to health care services as they re‐open are required to fully appreciate the health implications of the COVID‐19 epidemic, they added.

Meanwhile, a separate study from Victoria shows there has been a 50% reduction in survival from out of hospital cardiac arrest (OHCA) during the COVID-19 pandemic.

Using data from the Victorian Ambulance Cardiac Arrest Registry, researchers compared 380 adult OHCA patients who received resuscitation between 16th March 2020 and 12th May 2020, with 1218 cases occurring during the same dates in 2017-2019.

They found that while the incidence of OHCA did not differ during the pandemic period, initiation of resuscitation by Emergency Medical Services (EMS) significantly decreased (46.9% versus 40.6%, p = 0.001).

There was a 50% reduction in cardiac arrests in public locations in the pandemic period (20.8% versus 10.0%; p < 0.001), and a significant reduction in initial shocks by public access defibrillation/first-responders (p = 0.037).

EMS caseload decreased during the pandemic period, but  delays to key interventions (time-to-first defibrillation, time-to-first epinephrine) significantly increased.

Overall, survival-to-discharge decreased by 50% during the pandemic period (11.7% versus 6.1%; p = 0.002), resulting in 35 excess deaths per million person-years.

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