As the coronavirus pandemic unfolds, cardiologists around the globe are reporting a dramatic reduction in STEMIs. A recent study provides data that supports claims of missing STEMIs in the U.S. Read on to learn more about the study and theories about the drop in heart attacks.
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As cases of COVID-19 continue to rise in the U.S., cardiologists have been stumped by the drop in ST elevated myocardial infarction (STEMI) cases. In fact, physicians and hospitals around the world are asking, where are all the STEMIs? In Spain, the Spanish Society of Cardiology recently published a paper showing a 40% drop in STEMIs. An online article, The Mystery of the Missing STEMIs During the COVID-19 Pandemic, provides additional insight and estimates into the falling number of STEMI cases:
Jonathan Reiner, MD, at George Washington University Hospital, estimates the hospital recently treated just 2-3 STEMI cases in a 3-week period. Reiner reports they usually see 3 cases each week.
Bernhard Reimers, MD from Humanities Research Hospital in Milan, Italy, estimates STEMI cases are down by 70%.
Chandan Devireddy, MD, at Emory University School of Medicine in Atlanta, estimates a 20% to 50% drop in STEMIs in a 1-month period.
New Data Supports Claims
Although there's been observances and estimates of lower STEMI rates, there hasn't been any data to support the claims...until now. The findings of a study, led by Dr. Santiago Garcia, MD, at the Minneapolis Heart Institute at Abbott Northwest Hospital, reports findings consistent with the 40% drop in Spain. The study, published in the Journal of the American College of Cardiology, was conducted from January 1,2019 to March 31, 2020, with March 1 as the U.S. starting point for COVID-19.
Study Details
The study pulled data from nine high volume hospitals across the U.S. They used a specific model to look at cardiac catheterization laboratory activations from the previous year leading up to the first month of the COVID-19 U.S. outbreak. For STEMIs, it's crucial to activate the cardiac catheterization lab for percutaneous coronary intervention (PCI) for the best patient outcomes. The researchers found an astounding 38% drop in STEMIs during the study time period. The total STEMI activations went from >180 monthly to only 138 activations each month.
Why Is This Happening?
Some cardiologists expected heart attacks to increase based on the stress people are experiencing during the COVID- 19 outbreak. Also, viruses (like flu) have been shown to induce STEMIs resulting in activation of the cardiac lab team. So why are the numbers falling? There are several theories circulating among cardiologists.
Social Distancing and Sheltering at Home
We may be living a more sedentary lifestyle as we practice social distancing and quarantine to prevent giving coronavirus to other people. With gyms closed and sporting activities on hold, it is theorized that we are not engaging in strenuous activity that precipitates MIs. Some cardiologists suggest people are sleeping more and possibly smoking less (since virus attacks the lungs).
Commutes and Pollution
In many larger cities, pollution levels are high and getting to work can be very stressful. One theory is that with fewer cars on the road, pollution levels are much lower. And, without stressful commutes and crowded transit systems, overall daily stress is reduced.
Does the Virus Protect?
Although some cardiologists have suggested COVID-19 protects the cardiac systems of those infected. Dr. Reiner quickly debunks the theory since it’s not possible for the virus to reverse plaques or make plaques more stable. He believes there are other, more plausible explanations, stating “There have to be other behavioral issues having to do with people taking their medications, having lower blood pressure, I don’t know”.
Altruism and a Strained System
Another notion is potential patients want medical resources to be available for people who are worse off. Some people may be seeking help, but unable to be seen by a cardiologist or have tests done due to the strain on healthcare.
Leary of Medical Care
Could it be that people are afraid of getting COVID-19 in doctor offices, hospitals and emergency departments? Part of mitigation is limiting nonessential healthcare services, but perhaps some have difficulty knowing what is essential and what can wait.
Study Implications
Garcia and colleagues are planning to continue to study the underlying cause of STEMIs as the pandemic continues. The researchers are particularly interested in determining the role patient anxiety is playing in the number of STEMIs decreasing in U.S. hospitals.
Want Your Input
What factor or factors do you think are driving down STEMIs numbers?
