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As a cardiologist I’m deeply concerned about upcoming cardiac deaths for half of US states.
Historically this is leading cause of death.
I’ll share what we learned in NYC through the pandemic & cc experts @ASlavitt @DrEricDing @ashishkjha @AbraarKaran among others.
A thread...
Historically this is leading cause of death.
I’ll share what we learned in NYC through the pandemic & cc experts @ASlavitt @DrEricDing @ashishkjha @AbraarKaran among others.
A thread...
First, its important to recognize a pandemic means global reach & sustained community transmission. So states with low rates in Spring werent “spared”- they were just on a different timeline.
Look first at curves for Northeast states which peaked then flattened ( @NYTimes).
2/14
Look first at curves for Northeast states which peaked then flattened ( @NYTimes).
2/14
Now look at some other states (eg Arizona, Texas, Florida)- slopes shooting up like a rocket ( @NYTimes). Their slopes are now nearly identical to the NY curve early on.
So for all intents and purposes, assume patterns that happened in NY *may* also happen in other states.
3/14
So for all intents and purposes, assume patterns that happened in NY *may* also happen in other states.
3/14
Why do cardiac deaths concern me during a pandemic?
Well CVD is normally the leading cause of death across the US & it doesn’t stop just because of coronavirus.
CV deaths are often avoidable. So what happened to CV patients in NYC through the pandemic?
Many died at home.
4/14
Well CVD is normally the leading cause of death across the US & it doesn’t stop just because of coronavirus.
CV deaths are often avoidable. So what happened to CV patients in NYC through the pandemic?
Many died at home.
4/14
Data from @CDCgov and analysis by @nytimes shows 6,000 more deaths from heart disease this year from March 15 to May 2 in NYC alone. That’s 3X usual rates!
https://www.nytimes.com/interactive/2020/06/01/us/coronavirus-deaths-new-york-new-jersey.html
5/14
https://www.nytimes.com/interactive/2020/06/01/us/coronavirus-deaths-new-york-new-jersey.html
5/14
This is corroborated by cardiac arrest calls which surged by 4X, and cardiac deaths which surged by 8X!
*Data from NYC emergency responders and reported by @TheEconomist here ( https://www.economist.com/graphic-detail/2020/04/13/deaths-from-cardiac-arrests-have-surged-in-new-york-city)
6/14
*Data from NYC emergency responders and reported by @TheEconomist here ( https://www.economist.com/graphic-detail/2020/04/13/deaths-from-cardiac-arrests-have-surged-in-new-york-city)
6/14
Cath lab volume and heart attack admissions also decreased by as much as 50% per cardiologist poll results and as discussed by @hmkyale here
https://www.nytimes.com/2020/04/06/well/live/coronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html
7/14
https://www.nytimes.com/2020/04/06/well/live/coronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html
7/14
For my nonmedical friends, some heart attacks and all cardiac arrests represent *imminent* danger.
High risk heart attacks (Killip class 4) historically have up to 80% mortality if untreated. That’s markedly higher than Covid.
So “time is muscle” as we say in cardiology.
8/14
High risk heart attacks (Killip class 4) historically have up to 80% mortality if untreated. That’s markedly higher than Covid.
So “time is muscle” as we say in cardiology.
8/14
During the Covid peak, patients were afraid (or unable) to seek hospital care.
What about those that did? There was the additional burden of being in an overwhelmed hospital system - right when you need it most.
See ICU mortality in NYC early on.
https://jamanetwork.com/journals/jama/fullarticle/2765184
9/14
What about those that did? There was the additional burden of being in an overwhelmed hospital system - right when you need it most.
See ICU mortality in NYC early on.
https://jamanetwork.com/journals/jama/fullarticle/2765184
9/14
So where are health systems now in states with rising cases?
Take for example, the Banner health system in AZ which has been warning for weeks that ICUs and ECMO services are at capacity. So that Killip 4 patient’s chances for recovery go down.
https://twitter.com/bannerhealth/status/1270094394570321921?s=21
10/14
Take for example, the Banner health system in AZ which has been warning for weeks that ICUs and ECMO services are at capacity. So that Killip 4 patient’s chances for recovery go down.
https://twitter.com/bannerhealth/status/1270094394570321921?s=21
10/14
Today many states are still debating masks in piecemeal fashion. At this point mask mandates arent only necessary, theyre grossly inadequate.
State governments need to work immediately and diligently to support hospital systems and prep for a potential cardiac nightmare.
11/14
State governments need to work immediately and diligently to support hospital systems and prep for a potential cardiac nightmare.
11/14
Governments cannot work independently from health systems. They must coordinate.
There must be careful messaging that cardiac patients and those experiencing chest pain should *not* avoid urgent care.
Cath labs need to continue to prepare, train, prepare, and train more.
12/14
There must be careful messaging that cardiac patients and those experiencing chest pain should *not* avoid urgent care.
Cath labs need to continue to prepare, train, prepare, and train more.
12/14
Further guidance provided by American College of Cardiology @ACCinTouch here https://www.onlinejacc.org/content/75/18/2372
And if you’re not following @ASlavitt @DrEricDing @ashishkjha @Abraarkaran theyre all outstanding resources that have shed light on mask policies & covid rates ad nauseam.
13/14
And if you’re not following @ASlavitt @DrEricDing @ashishkjha @Abraarkaran theyre all outstanding resources that have shed light on mask policies & covid rates ad nauseam.
13/14
In NYC our cath labs were proactive in establishing priority, defining command structure, trying to secure PPE, building Covid test protocols & facilitating rapid discharge. Still that wasnt enough to prevent thousands of excess CV deaths.
Its not too late for other states.
End
Its not too late for other states.
End
