Heart attack patients may have delayed care over COVID-19 concerns

A study of Kaiser Permanente Southern California members shows that rates of hospital admissions or emergency department visits for heart attacks dropped significantly after stay-at-home orders for the COVID-19 pandemic began in 2020. These findings, published in The Permanente Journal on December 13, 2021, suggest that people may have delayed seeking care out of concern that they might be exposed to COVID-19.

“Our research underscores the importance of public health messaging that encourages people to seek emergency care for life-threatening conditions, even during stay-at-home orders,” said the study’s lead author, Matthew Mefford, PhD, a research scientist in the Kaiser Permanente Southern California  Department of Research & Evaluation.

The new study adds to growing evidence that health care visits in general, including visits to emergency departments, declined dramatically across the United States. during the pandemic—perhaps due to uncertainties and fears around COVID-19.

To better understand how the pandemic may have affected visits for heart attacks, Dr. Mefford and colleagues compared rates for this condition from before and after the pandemic began.

Specifically, they examined rates of hospitalizations or emergency department visits for heart attacks from the period of January 1 to March 4, 2020, before the Governor of California declared a State of Emergency, as well as from March 20 to July 31, 2020, after stay-at-home orders were enacted. They compared these rates for the same time periods in 2019, before the pandemic began. The analysis included all Kaiser Permanente Southern California members ages 18 and older and identified 7,019 patients with heart attacks.

The researchers found that heart attack rates were 15% lower from March 20 through July 2020, compared to the same period in 2019. However, no significant difference was seen for these rates between the pre-pandemic period of January through early March 2020 and the same period in 2019.

“We saw a big drop off once stay-at-home orders went into effect,” Dr. Mefford said. “However, during the summer of 2020, the rates started to rebound, suggesting that more people were seeking care for urgent conditions again.”

The research team also investigated whether there were any notable differences between patients who were treated for heart attacks during the pandemic versus the same period in 2019. Indeed, those coming to the hospital for heart attacks during the pandemic were more likely to have had a prior heart attack.

“This finding emphasizes that patients’ understanding of the urgency of their condition may be an important factor in their willingness to seek care, which could help guide development of new patient education strategies,” Dr. Mefford said.

The analysis also found that people who were hospitalized or had an emergency department visit for heart attacks during the pandemic were less likely to have high blood pressure, chronic kidney disease, and major depression. In addition, mortality rates for these patients were higher during the pandemic than in 2019.

Future research could look more deeply into a variety of potential explanations for these findings. And as the pandemic continues, future studies could address how care-seeking for heart attacks continues to evolve.

Overall, alongside similar findings from Kaiser Permanente Northern California, the researchers hope their new study will help inform patient education efforts at Kaiser Permanente, as well as public health messaging across the country.

“Bottom line, we need to make sure our members know that it is always critical for everyone to seek care for medical emergencies, even during public health crises,” said the study’s senior author Kristi Reynolds, PhD, MPH,  director of the Division of Epidemiologic Research at the Department of Research & Evaluation. “A delay in care could result in long-lasting disability or even death.”

The study was supported by funding from the Southern California Permanente Medical Group.

Co-authors include Jaejin An, PhD; Teresa N. Harrison SM; Steven J. Jacobsen, MD, PhD; Paul Muntner, PhD;, and Lei Qian, PhD, of the Department of Research & Evaluation; Nigel Gupta, MD, and Mingsum Lee, MD, of Kaiser Permanente Los Angeles Medical Center; and Chileshe Nkonde-Price, MD, of Kaiser Permanente West Los Angeles Medical Center.