Frightening spike in out-of-hospital cardiac arrests during COVID-19: Italian study
Researchers in Northern Italy observed 58% increase in the number of out-of-hospital cardiac arrests (OHCAs) in the first 40 days of the COVID-19 pandemic there, as compared with the same period last year.
The nember of OHCAs was steepest in the two provinces that experienced the earliest cases of COVID-19 and had the highest number of cumulative cases per 100,000 people, Simone Savastano, MD (Fondazione IRCCS Policlinico San Matteo, Pavia, Italy), senior author on the study, told TCTMD.
187% increase in the province of Lodi
For the province of Lodi, the increase in OHCA was 187%, and for Cremona, it was 143%. In Pavia and Mantova, where the epidemic hit later and fewer people were infected per capita, the increases in cardiac arrest were 24% and 18%, respectively.
When the COVID epidemic started, we noticed an important reduction in STEMI and so some of us thought that maybe cardiac arrest can also be reduced, so we questioned our database and very quickly we had a terrible answer,” Savastano explains. “It was exactly the contrary: out-of-hospital cardiac arrests were increasing day by day, and they went hand in hand with the COVID-19 trend.”
Principal reason - patients avoiding hospitals
There’s mounting evidence around the world that the principal reason for the drop in STEMI cases is patients avoiding hospitals out of fear of infection or concerns that hospitals are too overwhelmed to care for them. Some of these “missing STEMIs” are arriving to the hospital late, with dire complications from that delay. But cardiologists are worrying more and more that many patients are arresting and dying at home, the cause of death impossible to disentangle from COVID-19.
First to provide a snapshot of cardiac arrest numbers
Savastano believes their Lombardy data, published as a research letter in the New England Journal of Medicine, is the first to provide a snapshot of cardiac arrest numbers in a region hit hard, and hit early, by the COVID-19 pandemic. And as the data may be representative of other countries as well, the researchers decided to publish it as an early letter, in order to get this information out quickly.
As a whole, there were 362 OHCAs between February 20 and March 31, 2020, as compared with 229 in over the same period in 2019. Among the 2020 patients, 103 had confirmed or suspected COVID-19. While it’s impossible to differentiate between arrests directly caused by complications of COVID-19 versus those resulting indirectly, as a result of hospital avoidance, the authors estimate that COVID-19 accounts for 77.4% of the increase in cases of out-of-hospital cardiac arrest observed in these four Italian provinces.