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Scared of COVID, heart attack patients waste ‘golden hour’ before hospitalizing

Israeli heart attack patients have put their lives at risk during the pandemic by waiting an unusually long time before going to hospital due to fears of catching coronavirus, a major study has concluded.

Patients took an hour longer to get to the hospital during March and April this year than they did in 2018, cardiologist Shlomi Matetzky, head of the ICU at Sheba Medical Center outside Tel Aviv, told The Times of Israel, after analyzing statistics for 1,500 patients from 13 Israeli hospitals.

These included Sheba, Tel Aviv Sourasky Medical Center, Jerusalem’s Shaare Zedek Medical Center, and other large establishments.

“My main finding is that patients came one hour later, and we are talking about the golden hour,” he said. “For two decades we’ve been urging patients to come earlier — this is the hour during which we see sudden death, and during this hour we have a good chance of saving patients.

“People were hesitating about coming to the hospital, and that’s a big mistake. The result is that people risk more damage to the heart, and are more likely be in shock and to have serious heart failure.”

He added: “We think this happened because people were afraid to go to the hospital because they heard all the time about coronavirus patients in the hospital.”

Doctors have been warning about the knock-on health impact of the pandemic since its early days, and in April a leading physician told The Times of Israel he feared that the disruption wrought on Israeli healthcare by the coronavirus crisis could kill more people than the disease itself.

The new study, not yet peer reviewed, has been submitted to the Journal of the American College of Cardiology. Statistics are not available to show how quickly heart attack patients have been arriving at hospitals since April.

Matetzky said that the delays seem to have taken a heavy toll on the patients’ health.

He said that compared to 2018 there was a 60 percent increase in heart attack patients reaching the most serious “clinical endpoints,” namely death, heart failure, and malignant ventricular arrhythmia.

There was an increase of death during hospitalization from 3.4% of patients during 2018 to 4.3% in March and April.

Matetzky stressed that data was adjusted so it wasn’t distorted by differences in the general health condition of those hospitalized in March and April compared to 2018.

On the upside, Matetzky found that Israelis had bucked an international trend of heart attack patients staying away from the hospital altogether.

The number of heart attack patients seeking urgent hospital care dropped by more than 50% during the COVID-19 outbreak, a survey by the European Society of Cardiology found.

Its researchers spoke to 3,101 healthcare professionals in 141 countries in April, and published in a peer-reviewed journal.

In Israel, Matetzky found that there was actually an increase in people going to the hospital after a cardiac event. There were 12% more heart attack patients arriving compared to 2018, and 2% more serious heart attack patients.

Matetzky said that there is a good explanation for the increase: Times of crisis generally trigger an increase in heart attacks. He said he suspected — though there are no statistics to prove it — that the increase in Israel’s heart attacks was larger than the spike discernible from the figures.

“I suspect that some people stayed home, and in some cases died at home,” he said, adding: “I urge people, despite coronavirus, to go the hospital if necessary, and also to not neglect day-to-day medicine.”

Matetzky doesn’t blame any policy decisions for hesitancy to hospitalize, and said it was a product of the highly unusual nature of the current crisis.

“Usually in a disaster, like missile attacks, wars and other problems, the hospital is seen as a shelter that people run to,” he said. “Here, the disaster causes fears related to the medical system itself. This didn’t happen in the last 100 years, so from a historical perspective it’s interesting.”

Original: Nathan Jeffay – TOI