911 calls for heart attacks tripled in New York City amid COVID-19 outbreak; victims more likely to die, study finds

New Yorkers had nearly three times more heart attacks during the COVID-19 surge this spring, than in a typical year, and they were far more likely to die from them, according a study published today.

The study tracked 911 calls in New York City from March 1, when the city reported its first case of COVID-19, through April 25, when the surge had passed.

On April 6, the single worst day, there were 306 calls from friends and neighbors reporting people who had collapsed at home or on the street, compared with a typical day when 40 to 50 New Yorkers might have a cardiovascular event outside a hospital, said Dr. David Prezant, an author of the study and chief medical officer of the New York Fire Department.

COVID-19 clearly played a role in these heart attacks but exactly what role isn't clear, Prezant said, because few autopsies or COVID-19 tests were performed on the deceased.

Some likely would have cardiac arrests regardless of COVID-19, but perhaps were afraid of catching the virus at a hospital, so they stayed home despite signs of heart trouble. Many people with heart attack symptoms have avoided hospitals during the pandemic, studies have shown.

Others died more directly of COVID-19, Prezant said, either from a sudden heart attack or blood clot triggered by the disease, or a slowly progressive infection, which could have been treatable. Many people have thought of COVID-19 as a virus that affects the lungs, but studies have found that it can directly cause heart damage in some patients. 

The study, published in JAMA Cardiology, found there were nearly three times more 911 calls for cardiac arrest than in the same period a year earlier – 3,989 compared to 1,336. More than 90% of the calls this spring ended in death, compared with 75% a year earlier. The study looked only at adults who had heart attacks outside of hospitals and where 911 was called.

The people most likely to collapse were older, nonwhite and with existing medical conditions, such as hypertension, diabetes and physical limitations, the study found.

First responders were unable to shock the typical number of patients' hearts back into a normal rhythm, and used ventilators less often. It's not clear whether that was because of the patients' conditions or because the emergency responders reacted differently during the height of the local outbreak.

All had adequate personal protective equipment, including fresh, medical grade, N95 masks, gowns, eye protection, and gloves, Prezant noted.

Prezant, also a professor of medicine at Albert Einstein College of Medicine, said this suggests that health care providers need to do more during an outbreak to keep up with society's most vulnerable.

"Our call-out is to not deal with this the same way next time," he said, suggesting more patient outreach is needed for vulnerable populations, including telemedicine, and tracking of blood oxygen levels in those with COVID-19. "So that hopefully, we could intervene at an early time."

He advises, for instance, that high-risk people sick with COVID-19 be given pulse oximeters – a device placed around a finger that measures blood oxygen levels. Declining blood oxygen levels can indicate worsening infection.

"We do not have proof that having a pulse oximeter is going to solve this problem, but common sense would argue that that is something we should provide and utilize," he said, adding it's probably more predictive of a bad outcome than a temperature check.

Hospitals and medical facilities also need to make more of an effort to reach out to vulnerable patients, tracking them through telemedicine, perhaps, even if they don't have the latest technology or fast Wi-Fi access.

"We have to do better at bringing outpatient monitoring to these people," he said.

Dr. Harlan Krumholz, a cardiologist at Yale University, said it's not news that vulnerable people with COVID, especially those who are short of breath or having declining blood oxygen levels, need extra attention.

"This punctuates it," he said in an email. "COVID-19 is particularly challenging because people can decline rapidly – so we need to be extra alert – and people should not be shy to ask for help."

Dr. Eric Topol, a cardiologist and executive vice president of the Scripps Research Institute in California, said the best way to protect people from such outcomes is to prevent a resurgence of the virus.

"If you can stay ahead of cases before there's another outbreak, that's our best prevention," he said, emphasizing physical distancing, mask wearing and other public health measures.

There are still New Yorkers with COVID-19, Prezant said, and it appears people continue to worry that they will catch the virus if they seek medical care. In a typical week, there are about 4,000 911 calls in New York City, he said. In the first week of April, there were nearly 6,500, and it's now hovering around 3,300 calls a day. 

Contact Weintraub at kweintraub@usatoday.

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