Fear of COVID didn’t keep people having a heart attack from going to hospital

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Nova Scotians didn’t let their fear of contracting COVID-19 keep them from going to the hospital when experiencing heart attacks and strokes.

That’s one of the preliminary findings from Dr. Ratika Parkash’s ongoing research. The cardiologist, researcher, and Dalhousie University professor is looking at how the province’s pandemic response has affected the health and impacted the mortality rates of heart and stroke patients throughout Nova Scotia. 

“The bottom line is it appears that Nova Scotians came to the hospital when they needed to come. There are certainly some patients that we hear about anecdotally that didn’t come because they were scared and got sick,” Parkash said in an interview. 

“But when you look at the overall picture, we’re not seeing a lot of signals that there was an overall detrimental effect to the health of Nova Scotians because they were afraid of coming to the hospital because of COVID.”

Dr. Ratika Parkash. Photo: Dalhousie University

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Parkash and her team took their first crack at the data on Monday. She said the data collection process is challenging because there’s no “one-stop shop.” They’re using their own hospital-based administrative systems in addition to working with numerous organizations like Health Data Nova Scotia and Cardiovascular Health Nova Scotia to pull everything together.

Emergency department data around pre-COVID cardiovascular outcomes compared with outcomes after the pandemic started indicates a “slight increase” in the amount of time patients waited to go to hospital following the onset of heart attack symptoms.

But Parkash said it wasn’t deemed statistically significant. There was also no significant drop in the number of patients showing up at the emergency department because of a stroke or a mini stroke. 

“I focused on acute conditions. So this is acute cardiovascular conditions and stroke and so on, those are the things that can cause people to die at home,” she said. “Certainly from an acute care point of view, I think it’s a good news story.”

Parkash was a little surprised by the findings because of anecdotal reports suggesting Nova Scotia patients were staying home during the pandemic and becoming more sick rather than heading straight for the emergency department. She said those anecdotes weren’t enough to “move the needle” to a point where people were dying from not seeking care. 

“That’s quite reassuring, because we may get a second wave,” she said.

The Nova Scotia Health Authority’s Central Zone includes the Halifax region and accounts for half of Nova Scotia’s population. Parkash said 2,800 Central Zone patients presented to emergency with cardiovascular conditions between March 17 and May 21, their COVID research period. That was an 18% drop when compared with the 3,400 patients who went to the emergency department with those same conditions over the same time period last year.

Parkash’s next step involves stitching data together for a complete picture that includes all of the statistical analysis. They’re also working on gleaning data from hospitalizations and mortality rates for patients who were waiting for cardiovascular procedures during this period of the pandemic.

“If we look at patients waiting for procedures, we had over 200 on the waitlist during COVID. About 7% of those had to come to the hospital or got admitted, and 1.5% died on that waitlist, which may not be very different from before,” she said. 

“So we’re trying to get the before numbers sorted out. The patients that died were mostly patients waiting for a valve-related procedure, so they’re the sickest.”

Although her research thus far has focused on acute cardiovascular patients, she intends to look at chronic cardiovascular disease (heart failure) patients. They’ll examine COVID’s impact on those chronically ill patients by focusing on the QEII Health Sciences Centre heart failure clinic. 

If a second wave of COVID-19 does hit the province, Parkash said they now have “good confidence” in their ability to safely manage patients without COVID who become ill. 

“They’re not going to be stroking out at home or dying of heart attacks,” Parkash said. “We can also reassure them that they can come to the hospital safely, we can look after them, they’re not going to get COVID.”

Parkash said her research also provides reassurance to Nova Scotians that we managed to get through COVID-19 “without a huge detriment” to the health of our population. 

“From all of this work that we’ve done is a message that if you have a problem with your heart or you’re having a stroke, come to hospital, don’t stay home,” she said. 

Earlier this month, the European Society of Cardiology published an article suggesting COVID-19 fears were keeping “more than half” of heart attack patients worldwide away from hospitals. The ESC survey was conducted in mid-April and consisted of 3,101 health care professionals in 141 countries.

The Nova Scotia data so far appears to buck that trend. 

Parkash hopes to have a report ready within the next few weeks. She expects when their report is eventually published in a medical journal, it will attract a great deal of interest because the Nova Scotia data is attractive to researchers from other jurisdictions.

“We are a low COVID province, and so it kind of gives you a snapshot of what happens when you dial back all of the services. What happens in those types of scenarios,” she said.

“That’s the advantage of our data over some of the data that’s released from other cities or other jurisdictions that are high COVID areas. You’re couching all of the outcomes in the context of having to deal with this pandemic, whereas here we had a pandemic but it wasn’t as severe.”

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