Researchers Report Sharp Decline in Patient Visits for Heart Attack, Stroke and Cancer Care During COVID-19 Pandemic

Boston, Mass. – Five days after Massachusetts officials declared a state of emergency in response to rising cases of COVID-19, the state’s Department of Public Health directed all hospitals to postpone or cancel all nonessential procedures. While the order explicitly allowed for life-sustaining interventions for urgent conditions, physicians noticed a precipitous drop-off in emergency visits for heart attacks, strokes and other ailments.

In a new study, physician-scientists quantified the effect of the COVID-19 pandemic on the numbers of patients seeking medical attention for select potentially life-threatening diagnoses at Beth Israel Deaconess Medical Center (BIDMC), a large tertiary-care academic medical center in Boston that is part of Beth Israel Lahey Health.  The team found that patient encounters for heart attack and stroke dropped by about a third and more than half, respectively, during the pandemic compared to patient visits during the same period in 2019. The researchers have released a pre-print of the findings on MedRXiv.

“We found marked declines in patient visits for emergent and urgent conditions during the pandemic,” said corresponding author Dhruv S. Kazi, MD, MSc, MS, Assistant Director of BIDMC’s Smith Center for Outcomes Research in Cardiology and Director of BIDMC’s Cardiac Critical Care Unit. “Our data suggest that patients are deferring life-saving care due to fear of contagion.”

Kazi and colleagues selected conditions for which patients would be expected to seek care under normal circumstances. These conditions included heart attack and stroke, which warrant a visit to an emergency department, as well as outpatient but urgent diagnoses, such as new referrals for breast and blood cancers.

Next, using de-identified data, the team compared the number of patient encounters for each condition during the pandemic (March – April 2020) to the numbers of visits for the same conditions earlier this year (January – February 2020), with data from the equivalent periods in 2019 as a control.

Using a statistical approach known as a difference-in-differences analysis, the research revealed a 33 percent decline in the number of patients presenting with heart attack symptoms during March and April of 2020 compared to 2019. The number of patients seeking care for stroke dropped by 58 percent. Kazi and colleagues also observed about a two-thirds decline in referrals for breast cancer and blood cancers in 2020 compared to 2019, though that change did not become apparent in the data until April 1, 2020.

While the decline in patients experiencing heart attack and strokes may be partially due to a true drop in these events due to the sudden change in lifestyles and improved air quality during the lockdown, these factors are unlikely to explain the entire decline, the researchers note. Instead, Kazi and colleagues’ findings suggest people avoided seeking life-saving care out of fear of contagion and possibly died at home, as evidenced by the state’s large increase in at-home deaths during the COVID-19 pandemic.

Short-term lifestyle changes cannot explain the decline in referrals for new cancer diagnoses, Kazi added. The team’s findings suggest that drop was more likely due to deferred screening and primary care visits during the lockdown. The majority of breast cancers are diagnosed via mammography, and many patients with blood cancers may first present to primary care with minor symptoms. Disruptions in seemingly elective outpatient care could lead to delays in these diagnoses.

“Early announcement of stay-at-home orders likely flattened the COVID-19 curve in the Commonwealth of Massachusetts, but given the time-sensitive nature of initiating treatment for heart attacks and strokes, we need to improve public health messaging to ensure that patients continue to seek care for acute emergencies,” said Kazi. “We need to remind our patients that if they experience symptoms of a heart attack or stroke, they deserve the same life-saving treatment we offered before this pandemic set in. They should not try and sit it out.”

Co-authors included Rishi K. Wadhera, MD, MPP, MPhil; Changyu Shen, PhD; Rushad Patell, MD; Magdy H. Selim, MD, PhD; John Urwin, MD; Mark L. Zeidel, MD; Peter Zimetbaum, MD; and Robert W. Yeh, MD, MSc, of BIDMC; Kalon K. L. Ho, MD, MSc, of Harvard Medical School; and Kevin Tabb, MD, of Beth Israel Lahey Health.