The Decline In Cardiovascular Hospitalizations… Why?

According to a recent Kaiser Permanente study, the large decrease in heart attack hospitalizations and emergency treatment for suspected strokes found in Northern California at the start of the COVID-19 pandemic were not seen in later surges.

The Decline In Cardiovascular Hospitalizations… Why?

The study, published in JAMA on June 2, reveals that public health initiatives encouraging individuals to seek care if they had signs or symptoms of a stroke or heart attack were beneficial.

According to the study’s lead author, Matthew D. Solomon, MD, Ph.D., a cardiologist for The Permanente Medical Group and a physician-researcher with the Kaiser Permanente Northern California Division of Research, the weekly number of patients admitted to hospitals for a heart attack fell to nearly half of what would be expected in the early months of the pandemic. This follow-up research indicates that they were successful in convincing patients that it was crucial to leave their homes and seek emergency treatment if necessary and that they could do so securely.

The study looked at weekly incidence rates for people admitted to Kaiser Permanente of Northern California with a heart attack or suspected stroke from January 22, 2019, to January 18, 2021. The researchers next compared the incidence rates for the three COVID-19 spikes in the spring (March 10 to May 4, 2020), summer (June 23 to August 17, 2020), and winter (November 3, 2020, to January 8, 2021) to the same weeks the previous year.

The study found that weekly inpatient heart attack and suspected stroke rates fell during the COVID-19 spring increase but then rebounded to 2019 levels. Hospitalization rates for heart attacks were steady through the subsequent and considerably higher increases in COVID-19 infections and admissions. During the summer COVID-19 spike, there was a slight but statistically significant drop in suspected strokes, but the rates returned and did not fall during the biggest winter COVID-19 surge.

They published research in August 2020 that described decreased stroke presentations and discharges, which made them very concerned about patients who would be at risk for long-term disabilities because they did not come to the hospital for evaluation and treatment, according to study co-author Mai N. Nguyen-Huynh, MD, a research scientist with the Division of Research and the regional director of PRI. As a result, they increased their efforts to educate their patients about the need of calling 911 and going to the nearest stroke clinic if they have stroke symptoms. According to the findings of this study, such efforts paid off.

Kaiser Permanente Northern California and the Division of Research were in an ideal location to conduct this research. The study highlights the embedded regional research team’s unique ability to respond quickly in collaboration with a multidisciplinary team of clinical and methodological experts to gain insights from electronic health record data to inform care planning and delivery for a large, diverse population, according to the study’s senior author, Alan S. Go, MD, associate director of cardiovascular and metabolic diseases research in the Division of Research, as well as The Permanente Medical Group’s regional medical director of clinical trials.

Dr. Solomon and Dr. Go’s study, which found that hospitalizations reduced to about half of what would be predicted during the initial months of the pandemic, was published in the New England Journal of Medicine on May 19, 2020. Dr. Nguyen-Huynh and her colleagues’ study on the decrease in stroke patients reporting to the emergency room following the pandemic’s commencement was published in Stroke on August 11, 2020.

Dr. Solomon stated that the objective is to eradicate cardiovascular disease. But, in the meanwhile, they want to make sure patients don’t put off obtaining required care.