Fear of coronavirus reduces heart attacks by 40%

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Diseases of the circulatory system, specifically ischemic heart diseases (heart attack, angina pectoris ...), were the leading cause of death in Spain in 2018 (28.3%), according to INE data, followed by cerebrovascular diseases, such as stroke (first cause in women). The heart attack caused the death of 14,521 people in our country in 2018. In other words: the heart attack kills more than the coronavirus .

But fear spreads faster than any virus. And it can be stronger than pain, which can be leading to people enduring heart attacks and other serious events at home . Cardiologists are concerned and, suspecting that this could be happening, launched a study with hospitals throughout Spain belonging to the heart attack code network, in which 95% of them have participated.

"We are concerned about this situation because the reduction does not respond to the epidemiological reality, but probably to the fear of patients to get Covid-19 if they go to the hospital. The risk of increased morbidity and mortality that this may represent is notable, especially in the case of acute myocardial infarction, "says Oriol Rodríguez Leor, member of the Association of Interventional Cardiology of the Spanish Society of Cardiology (SEC) and first signatory of the study.

Thus, the telematic survey of 71 Cardiology Services of the 17 autonomous communities makes a comparison between the week of February 24 to March 1 (when the virus had just hit the peninsula and the WHO had not yet declared a pandemic) and the one from March 16 to 22 (in full pandemic). During this time, a 48% reduction in structural procedures and 40% less primary angioplasties performed in cases of acute myocardial infarction (from 429 weekly to 258 on the dates studied) have been observed.

"That 48% less in structural procedures is closely related to the drop in diagnoses and that those without severe symptoms endure more at home. As for angioplasties, it is the usual procedure when suffering a heart attack, although the best results are they occur when it is performed within 120 minutes of suffering it, so it is important not to let time go by. That they are reduced is not because the cardiology units have stopped working ", Rodríguez Leor develops.

Other data points to a 57% reduction in diagnostic tests and an 81% reduction in structural procedure interventions, that is, "valve implants, mitral clips or cavity closure or interatrial communications, generally, interventions that are not Life or death. Anything that is not urgent is better postponed to stop the spread of Covid-19 . At the Germans Trias i Pujol Hospital in Badalona, ​​where I work, we are calling by phone and doing a screening. You should not wait because it is a risk to your health, we are citing it. Those who can wait will postpone the test, "adds the interventional cardiologist.

The report also points to a slight increase in the use of thrombolysis (treatment of infarction with intravenous drugs). "When the patient waits and consults much later, this option of drugs is considered, but in principle primary angioplasties continue to be carried out. It happens that if the hospital that is attended does not have the capacity, it transfers to another in a medical ambulance, but in the current situation is not as available and the transfer is more compromised, that is why we opted for the drug and a catheterization in the first 24 hours to see if angioplasty is also necessary. In any case, it is an almost anecdotal use, "he underlines. the cardiologist.

More pronounced in some communities

These data suggest that many people are putting up with the pain at home and that medical conditions that have been substantially reduced in Spain after the heart attack code was implemented in all regions can be produced in the coming months. " These networks have reduced hospital mortality from 25% to 5-10% , but if people do not attend on time, there will be more episodes of extensive heart attacks and sudden death. With the stroke code, perhaps the same thing will happen, although it is usually more bulky. If they lose their speech or become paralyzed, they will surely call the emergency department, but a heart attack has a more difficult diagnosis, sometimes they attribute it to another pain or a cut of digestion because they vomit, and that plays in against the patient ", assures the first signatory of the report.

Although this is a global trend throughout Spain, the report highlights some regions in which the rates of decrease in heart attack treatments are even higher. These are Extremadura (-85%), Castilla-La Mancha (-67%) and Andalucía and Asturias (-56%). At the other extreme are La Rioja, where no differences have been recorded, or Galicia (-11%) and the Basque Country (-8%), where the reduction has been smaller. " There is no clear explanation of why there are these differences and it has nothing to do with a higher incidence of Covid-19 because when adjusting the number of cases with the population, for example, Extremadura does not have too many cases," says the cardiologist. .

According to Rodríguez Leor, it would be interesting to be able to expand the data of this study, which will be published shortly in the scientific journal REC: Interventional Cardiology , "but this first survey has already involved a great effort because many centers have all their resources devoted to combating the coronavirus and it will be complicated. We have analyzed the initial stage, when the total confinement measures were not yet in place and the impact was very uneven by Autonomous Communities. It is an X-ray of the beginning, but my impression is that the non-urgent activity is still going to be reduced more . "

Finally, Rodríguez Leor stresses the problem that all the people whose attention is being postponed will pose a posteriori. "All these patients will have to be reprogrammed, a plan will have to be thought up, but not only in cardiology, but for all specialties, and that will overload the system. For now, all efforts must be focused on two things: stopping the Covid -19 and give attention to all urgent pathologies , such as heart attack, stroke or polytrauma, as it had been done. So now that we have noticed this decrease in cases we insist that people call 112 when they notice symptoms of heart attack, in that number they can screen and detect if it really is or not, and avoid complications and deaths, "he concludes.

Symptoms of acute myocardial infarction

In its report, the SEC recalls that on most occasions, not all symptoms occur, but a variable combination of some of them:

-Usually weight-like pain in the sternum area that is not modified with movements or breathing, quite intense and sometimes radiates to the jaw, neck and back, left arm , and in some cases right arm. It can be associated with cold sweat and dizziness.

-Other times it manifests with pain in the upper abdomen , shortness of breath, desire to vomit and loss of consciousness.

According to the criteria of The Trust Project

• Science and health
• Coronavirus
• Covid 19
• Cardiology

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