A new analysis in JAMA Cardiology paints a picture in data of the characteristics of individuals in New York City suffering from out-of-hospital cardiac arrest and even death during the COVID-19 pandemic.
Researchers for the analysis sought to tease out the characteristics (such as race/ethnicity, comorbidities, and emergency medical services [EMS] response) that are associated by out-of-hospital cardiac arrests and mortality. The population-based, cross-sectional study compared individuals experiencing cardiac arrest who received resuscitation via the New York City 911 EMS, and covered a period from March 1, 2020 through April 25, 2020. They then compared the data to the same period in 2019.
“Identifying patients at risk for out-of-hospital cardiac arrest and death during the COVID-19 pandemic should lead to interventions in the outpatient setting to help reduce out-of-hospital deaths,” the authors noted in their paper.
— JAMA Cardiology (@JAMACardio) June 19, 2020
The study included 5,325 patients (3,989 in the COVID-19 period and 1,336 in the comparison period). Incidence of nontraumatic out-of-hospital cardiac arrest was three times higher in 2020 than in the 2019 comparison period (47.5 per 100,000 vs. 15.9 per 100,000, respectively). Individuals experiencing out-of-hospital cardiac arrest during the 2020 study period tended to be older (mean age, 72), were less likely to be white, and were more likely to have comorbidities like hypertension and diabetes, and were more likely to posses physical limitations of some kind. Additionally, the odds of asystole (OR=3.50; 95% CI, 2.53 to 4.84) and pulseless electrical activity (OR=1.99; 95% CI, 1.31 to 3.02) increased during the COVID-19 study period. The return of spontaneous circulation and sustained return to spontaneous circulation were reduced during the COVID-19 period, with fatality rising to more than 90% (a relationship which remained statistically significant after adjustment for potential confounders).
“The findings of this cross-sectional study emphasize the importance of intervening early in the course of COVID-19 infection, before acute decompensation,” the authors wrote in the conclusion. “They also speak to the critical need to design better systems for providing health care access to vulnerable, at-risk patients with acute and chronic conditions during a pandemic. Aggressive efforts for identifying outpatient risk factors for out-of-hospital cardiac arrests and death, such as hypoxia and hypercoagulability, especially in minority populations, should be instituted.”
Study limitations included data limited to those who actually received care (EMS resuscitation), and a lack of post-mortem testing for COVID-19.
A doubling (and >4X at peak) of out-of-hospital cardiac arrests, with 90% of leading to deaths, in New York City during its #COVID19 outbreak @JAMACardio https://t.co/PbtzAvCoNY likely reflects collateral damage—fear of medical attention (covid & cardiac) + direct heart impact pic.twitter.com/jJwF1hF61T
— Eric Topol (@EricTopol) June 19, 2020
Characteristics Associated With OHCA & Resuscitations During the Novel COVID19 Pandemic in NYC. 3x higher rate of cardiac arrest compared to same time in 2019. Implications for #EMS https://t.co/Bt52MpNBtY #FOAMed #FOAMems #FOAMpara #paramedic
— 𝙳𝚊𝚗 𝙶𝚎𝚛𝚊𝚛𝚍, 𝙼𝚂, 𝚁𝙽, 𝙽𝚁𝙿 (@DanielRGerard) June 21, 2020
Out-of-hospital cardiac arrests and deaths during the COVID-19 pandemic significantly ⬆️ and were associated with older age, nonwhite race/ethnicity, hypertension, diabetes, physical limitations, and nonshockable presenting rhythms.@Drroxmehran @ajaykirtane @NMHheartdoc https://t.co/gmBC13ifcv
— Gregg Fonarow MD (@gcfmd) June 19, 2020