Emergency care for heart attacks and strokes rebounds

Kaiser Permanente study finds decrease reported during onset of COVID-19 pandemic was not seen in subsequent surges

By Sue Rochman

The significant declines in heart attack hospitalizations and emergency care for possible strokes seen in Northern California at the beginning of the COVID-19 pandemic were not seen in subsequent surges, new research from Kaiser Permanente shows.

The study, published June 2 in JAMA, suggests that public health campaigns encouraging people to seek care if they were experiencing signs or symptoms of a stroke or heart attack were effective.

“In May 2020 we reported that in the early months of the pandemic, the weekly number of patients admitted to our hospitals for heart attacks fell to nearly half of what would be expected,” said the study’s lead author Matthew D. Solomon, MD, PhD, a cardiologist at The Permanente Medical Group and a physician researcher at the Kaiser Permanente Division of Research. “This follow-up study suggests that we were successful in our efforts to reassure patients that it was important to leave their homes and seek emergency care if needed, and that they could do so safely.”

Comparing early pandemic rates with a year later

The research team analyzed weekly incidence rates for adults hospitalized with a heart attack or suspected stroke from Jan. 22, 2019, through Jan. 18, 2021 in Kaiser Permanente Northern California, a large, integrated health-care delivery system. They then compared incidence rates for the time periods during the 3 COVID-19 surges in the spring (March 10 to May 4, 2020), summer (June 23 to Aug. 17, 2020), and winter (Nov. 3, 2020, to Jan. 8, 2021) to the same weeks in the prior year.

We were successful in our efforts to reassure patients that it was important to leave their homes and seek emergency care if needed, and that they could do so safely.

— Matthew Solomon, MD, PhD

The study showed that weekly hospitalized heart attack and suspected stroke rates declined during the spring COVID-19 surge but then recovered to 2019 rates. During the subsequent and much larger surges in COVID-19 infections and admissions, hospitalization rates for heart attacks remained stable. A small but statistically significant decline in suspected strokes was seen during the summer COVID-19 surge, but the rates rebounded and did not decrease during the largest winter COVID-19 surge.

“In August 2020 we published research on decreased stroke presentations and discharges, which made us very concerned about patients who would be at risk for long-term disabilities because they were not coming to the hospital for evaluation and treatment,” said study co-author Mai N. Nguyen-Huynh, MD, regional director of primary stroke for The Permanente Medical Group and a research scientist at the Division of Research. “In response, we redoubled our efforts to educate our patients that if they have stroke symptoms, they should call 911 and go to the nearest stroke center. This study suggests those efforts paid off.”

Ensuring patients to not delay care

Kaiser Permanente Northern California and the Division of Research were ideally positioned to carry out this research. “Our study highlights the unique ability of our embedded regional research team to respond rapidly in collaboration with a multidisciplinary team of clinical and methodological experts to gain insights from our electronic health record data, to inform care planning and delivery for a large, diverse population,” said the study’s senior author, Alan S. Go, MD, regional medical director of clinical trials for The Permanente Medical Group and associate director of cardiovascular and metabolic conditions research at the Division of Research.

The study by Solomon and Go which showed that hospitalizations fell to nearly half of what would be expected during the first months of the pandemic was published May 19, 2020, in New England Journal of Medicine. The research by Nguyen-Huynh and her colleagues on the decrease in stroke patients reporting to the emergency room after the onset of the pandemic was published Aug. 11, 2020, in Stroke.

“Our goal is to stamp out cardiovascular disease,” Solomon said. “But until then, we want to ensure patients do not delay in seeking needed care.”

This study was supported by the Garfield Memorial Fund, and The Permanente Medical Group’s Physician Researcher Program and Delivery Science and Applied Research initiative .

Sue Rochman is a senior writer with the Kaiser Permanente Division of Research. This is reprinted from the Division of Research site.