Heart Attacks and Strokes During the Coronavirus Pandemic

Herbert D. Aronow, MD, MPH and Ryan McTaggart, MD
Heart attack and stroke during pandemic

While the world focuses on coronavirus, there appears to be a trend developing that is of great concern: hospitals are seeing fewer patients with heart attacks and strokes.

At one of the Lifespan hospitals, we have witnessed a 33 percent reduction in patients with heart attacks during March 2020 compared with the same month the three years prior. In speaking to our colleagues around the region, country and world, we have heard similar reports, with some observing up to a 70 percent reduction.  

Anecdotally, many of us have observed that during the coronavirus outbreak, when patients with heart attack and stroke do present to the hospital, they do so much later in the course of the event, after more damage has occurred.  As a consequence, they are much sicker and less likely to survive once they arrive at the hospital.

Why are there fewer patients?

There is a great deal of speculation around what may be causing this decline. Stay-at-home orders have removed triggers for heart attacks and strokes like excessive eating and drinking, and abrupt periods of physical exertion.  It is also possible that staying at home and complying with social distancing have led to less air pollution. But the most probable explanation - a reluctance to come to the hospital for fear of exposure to COVID-19 – is the most dangerous as it can lead to devastating delays in care.

The importance of prompt medical attention

The need to seek medical attention immediately for a confirmed or suspected heart attack or stroke has not changed during the COVID-19 pandemic.  The age-old adages “time is muscle” for heart attacks and “time is brain” for strokes remain true today.  The longer a patient waits for evaluation and treatment, the more damage that occurs, and this damage is typically permanent.

With stroke, for each minute of delay to treatment, patients lose one week of independence. The weeks you lose (if you survive at all) add up quickly if you don’t call 9-1-1 right away. Nearly all patients with COVID-19 recover and return to normal; stroke and heart attacks never go away if you delay treatment.

Watch for signs of heart attack and stroke

Heart attack: Symptoms of heart attack include chest discomfort (often described as pressure, heaviness, burning, or pain) which may travel to the neck, jaw, shoulder/s or arm/s, and which sometimes are associated with shortness of breath, sweating, or nausea. 

Stroke: You can easily remember the signs of stroke by remembering to BEFAST:

B - Balance: Is there a sudden loss of balance? Watch for leaning to one side or staggering when walking.
E - Eyes: Is there a sudden loss of vision in one or both eyes, of double vision that doesn't go away when you blink your eyes? Also, no side vision or vision above midline.  
F - Face: Ask the person to smile or stick out their tongue. Is the smile uneven, is the tongue deviated to one side or does one side of the face droop? A bit of drooling out of that side of the face may be present.  
A - Arms: Ask the person to raise both arms. Does one arm drift downward? Is there a sudden loss of coordination, numbness, or weakness of that arm?  For example, is the person suddenly unable to pick up a coffee cup or get it to his or her mouth? Does the arm or leg feel numb, or do they want to shake it all the time to wake it up like it's asleep?
S - Speech: Sudden difficulty in speaking or understanding. Can the person repeat a simple phrase? Does the speech sound slurred/strange/garbled? Does the person say he or she has a thick tongue or have difficulty swallowing?
T - Time: What do you do if you observe any of these signs in yourself or in someone you are with? Call 9-1-1; do not drive the person to the local emergency room. By contacting EMS, assessment and treatment can be started prior to arrival to the emergency department and time (brain) is saved. If known, note the time the patient was last seen well and give this information to emergency personnel along with any information you may have regarding the person’s current medications.  This will help determine what treatment the person is eligible for.

It is important to remember that your chance of dying or being permanently disabled from a heart attack or stroke is much higher than the average risk associated with coronavirus. Please don’t delay your call to 9-1-1 because of coronavirus concerns. We have processes in place so that your risk of exposure is negligible. Your concerns about having a heart attack or stroke should be far greater. 

Keeping our patients safe

Great efforts have been made to keep patients safe in the hospital, especially during the coronavirus outbreak.

  • We ask that patients wear masks to keep them from unknowingly spreading infection to other patients and health care workers.  
  • Patients with confirmed COVID-19 are ‘cohorted’ or kept together in the same nursing units away from other non-infected patients..
  • We have eliminated visitors as they might unknowingly bring COVID-19 into the hospital and expose patients and health care workers.
  • Health care workers are all wearing masks as well as other personal protective equipment, are handwashing even more often than usual, and are practicing social distancing.  

Doctors’ visits

If you are currently being treated for a heart condition or have experienced a stroke, it is very important to continue to interface with your health care provider to reduce your risk of future heart attack or stroke. Telehealth, or a visit with your provider using telephone or video chat, has become quite common during the pandemic. Routine checkups and even new visits are available today. You can get more information on telehealth here.

Even though significant personnel and resources have been devoted to the COVID-19 effort, we remain ready to care for all of your health care needs just as we always have.  No good will come from delaying care for a serious health condition like heart attack and stroke, so when in doubt, call 9-1-1.

The EMS professionals in our state are as good as they come and work in close partnership with the Lifespan Cardiovascular Institute and Comprehensive Stroke Center, so you get to the right place the first time.

Delivering health with care

At Lifespan, our mission is delivering health with care. We remain committed to the health of our community.  Please remember how important it is to maintain a healthy lifestyle through diet, exercise and stress management activities such as yoga and meditation. Please don’t smoke and continue taking all of your prescribed medications so you maintain good control of your blood pressure, cholesterol, and diabetes.

We are here for you 24/7/365.  Together, we will get through this.  Please stay safe, stay healthy and whenever possible, stay home.

For more on "Caring for your heart during COVID-19," watch Dr. Aronow.

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