Italian investigators believe theirs are the first published data showing high numbers of at-home cardiac arrests amid the pandemic.
Chilling numbers out of northern Italy point to a 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.
This spike in arrests appeared to follow the geographic time course of the outbreak, such that the percent increase in OHCA 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. 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 said. “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.”
The dramatic drop in acute MIs during the COVID-19 epidemic has emerged as a devastating side story, with cardiologists and researchers increasingly convinced that hospital avoidance by patients terrified of the contagion has helped to drive the numbers down. And while some of these “missing STEMIs” are arriving to the hospital late, with dire complications from that delay, there are growing fears that many patients are arresting and dying at home, the cause of death impossible to disentangle from COVID-19.