July 14, 2020

expert reaction to paper suggesting 5000 heart attack sufferers in England did not seek treatment due to the COVID-19 pandemic

A study, published in The Lancet, has suggested that 5000 heart attack sufferers in England did not seek treatment due to the COVID-19 pandemic.

Prof Steve Goodacre, Professor of Emergency Medicine, University of Sheffield, said:

“This important analysis shows the value of making NHS data available to researchers. It confirms that fewer people were admitted to hospital with heart attacks during the pandemic, compared to the same time last year, and it attempts to quantify the number of people who missed out on treatment.

“The paper only mentions the figure of 5000 heart attack sufferers missing out on treatment in the discussion, so it is unclear how this was calculated and the degree of certainty around this estimate. It would be interesting to see the modelling behind this and know whether they could estimate the number of avoidable deaths. I think there would probably be a few hundred avoidable deaths, given what we know about survival from heart attack and the effect of treatments on survival.

“It is worth noting that the 35% and 42% falls in admissions represent the maximum weekly falls, recorded at the end of March, rather than an average or overall fall in admissions across the first wave of the pandemic.

“The authors suggest that a national public information campaign might have contributed to the partial recovery in admission rates, but previous studies have shown little evidence of an effect from media or public information interventions on delays seeking help with a heart attack.

“It is worth noting that ambulance paramedics can diagnose the most serious type of heart attack using an ECG. They could also diagnose other heart attacks using a simple blood test that is currently used in A&E. Rather than focusing on reassuring people that hospital admission is safe, we might be better off ensuring that people only have to go to hospital if they have a confirmed heart attack.”

Dr Daniel Brayson, Research Fellow at UCL Great Ormond Street Institute of Child Health and Member of The Physiological Society, said:

“This research from a world leading centre confirms suspicions that fear of COVID-19 is likely causing people with vulnerable cardiovascular health to stay at home dying in unnecessary pain or in danger of developing severely life-limiting heart failure that timely treatment could otherwise mitigate/alleviate. It is vital that patients with signs of heart attack seek help instantly. COVID-19 or perceptions of overburdening the NHS should not be a consideration for patients with symptoms of heart attack – this cannot be emphasised clearly enough.”

Prof Tim Chico, Professor of Cardiovascular Medicine and Honorary Consultant Cardiologist, University of Sheffield, said:

“This study confirms the personal experience of many cardiologists; the start of the COVID-19 pandemic in the UK was associated with a huge fall in the number of patients coming to hospital with heart attacks. Although on the face of it a reduction in heart attacks would be welcome, the strong suspicion is that the true rate of heart attacks did not fall, but simply that people did not seek help for chest pain or other symptoms. The message to ‘protect the NHS’ can all too easily lead to patients trying to avoid seeking help, even for potentially life-threatening problems such as a heart attack.

“As well as this large reduction in the number of people coming to hospital, the experience in my own and other hospitals has been that those people who did come to hospital often waited at home for too long before calling for help, which we know is likely to have led to worse outcomes for these patients. However, this study does not tell us how many people died or will develop complications such as heart failure as a result of not seeking attention quickly enough. Unfortunately, COVID-19 has the potential to cause harm even to people not directly infected, as this study shows.”

Prof John Martin, Professor of Cardiovascular Medicine, University College London (UCL), said:

“There may be another explanation for these findings: there may have been a real reduction in heart attacks. There is some evidence that heart attacks might be precipitated by inflammatory illnesses which cause increase in blood coagulation which may lead to clots in the coronary artery. It has been observed that the isolation of lockdown has led to a decrease in non-COVID respiratory infections (data must be checked). Therefore, the decrease in heart attack presentation in hospital may be due to a real reduction in heart attacks due to the beneficial effects of lockdown.”

‘COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England’ by Marion Mafham et al. was published in The Lancet at 23:30 UK TIME on Tuesday 14^th July 2020.

DOI: 10.1016/S0140-6736(20)31356-8

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

Prof Tim Chico: “No conflicts”.

None others received.