Ischaemic heart disease

Stroke and MI patients not presenting to hospitals in COVID-19 pandemic


There is concern that the COVID-19 pandemic is discouraging people from presenting to hospital EDs – even those with symptoms of potentially urgent conditions such as heart attacks and stroke.

In the UK, the Emergency Department Syndromic Surveillance System has shown a fall off in total ED attendances over the last couple of weeks.

Attendances were significantly reduced compared to before the COVID-19 lockdown but also when compared to the same period last year.

According to a news item in the BMJ, it was a “well recognised but unexplained universal phenomenon that has also been observed in Australia, Canada, and Europe.”

“We don’t know whether there is less disease, whether it’s being managed differently, or whether people are at home with diseases that should be treated,” the Royal College of Emergency Medicine vice president Dr Ian Higginson said.

It was likely people were staying at home because of fear of exposure to the virus or not wanting to be a burden on the NHS at this time.

In Australia, the Stroke Foundation has joined with other members of the Australian Chronic Disease Prevention Alliance (ACDPA) in issuing a warning to the community not to leave it too late to call for urgent medical assistance, despite the risk of COVID-19.

ACDPA Chair Sharon McGowan said they were starting to hear some “heart-breaking” local stories.

“This includes two patients with stroke who stayed at home where their conditions worsened, instead of presenting to hospital. This is incredibly distressing because these patients could have received time-critical treatment but are enduring much more serious disabilities as a result of the delay”.

Austin Health stroke neurologist Professor Vincent Thijs confirmed to the limbic they were definitely seeing less activity on the wards.

“There has been a dramatic reduction in stroke calls and then when we have our stroke calls, they are often people who have waited at home with symptoms. So that is happening. It’s not only happening for stroke but for people with seizures, heart attacks, etc.”

“We are seeing big strokes still coming in but it is probably the milder ones that are not being reported and TIAs may also be reduced.”

He said the most obvious reason for the delay in seeking care was because people were afraid to enter hospitals.

But fewer social interactions also meant that friends or family members might not notice transient or minor signs such as a facial droop and encourage the people affected to seek care.

“It’s a complex space, I wouldn’t say it is only fear or anxiety.”

“It’s very important that every healthcare system adapts and what we have done for instance in our hospital, with our GP liaison, is inform our GPs that they should still send their patients but also that the stroke and neurology team are available. If they are in doubt, give us a call to discuss the situation.”

“All the hospitals have separate streams for their COVID patients and non-COVID patients so it is still safe to come into hospital if they really need it, and deferring care especially in the case of stroke can have dramatic consequences.”

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