ER sees reduced stroke, heart attack, doctors worry: shot

Doctors in the emergency room have seen fewer hospitalizations for heart attacks and strokes. They are worried that patients who delay treatment may eventually become ill and injured when they finally arrive in the emergency room.

Studio 642 / Getty Images / Tetra images RF

Hide description

Switch caption

Studio 642 / Getty Images / Tetra images RF

Doctors in the emergency room have seen fewer hospitalizations for heart attacks and strokes. They are worried that patients who delay treatment may eventually become ill and injured when they finally arrive in the emergency room.

Studio 642 / Getty Images / Tetra images RF

The patient described it as “the worst headache in her life.”

But she didn’t go to the hospital. Instead, the residents of Washington waited for almost a week.

When Dr. Avinito Chowderly Finally, she met her and discovered a cerebral hemorrhage that she had not been treated.

The neurosurgeon did his best, but it was too late.

“As a result, she died of several other strokes,” says Chowdhary, director of the Overlake Neuroscience Institute in Bellevue, Washington. “This is something we can prevent most of the time.”

He said the patient was a stroke survivor in his mid-50s and was scared of the hospital, Chowderly said.

She was afraid of the coronavirus.

It’s a deadly fallout that doctors in the United States have feared for weeks because they’ve been tracking trends of concern. The number of patients presenting to hospitals with severe cardiovascular emergencies, such as strokes and heart attacks, has dropped dramatically as the pandemic has taken root.

Doctors across the country call dropoffs phenomenal, unlike anything they’ve never seen in their careers. And they worry that a new wave of patients is heading in their direction, patients delay treatment and are now more ill and more injured when they finally arrive in the emergency room. Will do.

It surprised certain medical groups like American Heart Association The American Heart Association publishes an ad that encourages people to call 911 when they have symptoms of heart attack or stroke.

“Where are all these patients?”

Across the country, the amount of ER is decreasing by about 40-50%. Dr. William Jackis says, President American Emergency Clinic.

“I’ve never seen anything like that before,” he says. “In reality, more was expected.”

But doctors say the once-busy emergency room has settled into an eerie calm.

“It was so quiet that I was very scared,” he says. Dr. David Tashman, Dean of ER at USC Verdugo Hills Hospital about the early stages of the outbreak.

“We usually see 100 patients a day and then reduce to 30 or 40 overnight.”

Part of the reduction in the patient’s normal volume was intentional.

In case of a surge in COVID-19 patients, the hospital advised people to avoid emergency rooms whenever possible. Tashman was not surprised by the low number of trauma patients due to the open roads. But soon he and other ER doctors realized that even a really urgent case wouldn’t come in.

“We know that the number of heart attacks won’t decrease in a pandemic. That shouldn’t really happen,” says Tashman.

Dr. Larry StockER doctor at Antelope Valley Hospital in Lancaster, CA, wondered the same.

“That’s what we’ve been worried about. Where are these patients?” Says Stock. “They are at home and are beginning to get the tip of the iceberg for this phenomenon.”

1 Investigation We collected data from nine hospitals across the country and focused on the key procedures used to reopen an obstructed cardiac artery after a heart attack. The hospital performed 38% fewer of these procedures in March compared to the previous month.

At Harbor View Medical Center in Seattle, Dr. Marubika Sharma The number of stroke hospitalizations in the first half of April decreased by 60% compared to the previous year.

Nationwide stroke and heart attack 911 calls declined from March to early April, according to data collected by ESO, a software company used by EMS agencies.

In Connecticut, Dr. Kevin Shess I also noticed a similar trend at Yale New Haven Hospital.

Sheth started calling other stroke doctors and tried to understand what was happening.

“The numbers have dropped dramatically almost everywhere,” says Schett, head of the Department of Neurological Critical Care and Emergency Neurology at Yale University School of Medicine. “This is a big issue from a public health perspective.”

Sheth says at clinical stroke centers, there is an “unprecedented” reduction in stroke patients undergoing treatment, with a reduction range of 50-70%.

In April, the American Heart and Stroke Association Emergency guidance To ensure that the healthcare provider keeps the stroke team active and ready to treat the patient during the pandemic.

Sheth is worried that delays in treatment could further exacerbate the condition of all patients who eventually appear in the hospital.

“When these stroke numbers come back, we may have serious capacity problems,” he says. “We were already bursting at the seams.”

“People are in this fear mode” Dr. John Harold, A cardiologist at Cedars-Sinai Medical Center in Los Angeles, and chair of the American Heart Association’s Los Angeles Branch.

Harold says the full public health implications of those who avoid hospitals are still unclear.

“The big question is whether these people are dead at home,” he says.

Patients fearing hospitalization

Patients already at high risk of experiencing a medical emergency describe a mixture of fear and confusion about how to receive safe and appropriate treatment.

In March, Dustin Domzalskiran did not use the drugs used to treat epilepsy.

A 35-year-old from Bellingham, Washington, he had difficulty contacting the doctor he would normally meet in person to get replacements.

Within days of not taking the medicine, he had a major seizure while taking a shower. His caregiver called an ambulance, which took him to the ER.

“I woke up and asked where I was and what happened,” Domusalski said. “The man in the room next to me was coughing and doing all sorts of things.”

The experience was so disturbing that Donzarsky plans to avoid hospitals if possible.

“I won’t go to the hospital unless I have a seizure and hurt myself,” he says. “It’s better to stay here because it can cause problems with viruses.”

Stake Simpson, who lives in Miami, evoked a horrific test when he went to the emergency room in mid-March.

A cancer survivor with heart failure, Simpson woke up with a heartbeat that worried she might have a heart attack.

At the hospital, she was screened for coronavirus, coughed, and was immediately transferred to the ward for suspicious cases, a condition of heart failure.

“When I found out that reality was in the COVID unit, I thought I would probably do it now, if I didn’t have it,” Simpson says.

She spent a day there feeling uneasy. Six days later, when I returned home, she found out that the test for the virus was negative.

Simpson knows that the hospital has made many changes since the early days of the pandemic, but the idea of ​​calling 911 still scares her.

“I saw a news report saying it’s safer now … I don’t know if it’s now completely confident about it,” she says. “The risk of COVID is horrific.”

In Los Angeles, Jacqueline Alicani, 60, has the same fear. She had a rare heart condition, diabetes, and had a stroke a few years ago.

A few weeks ago she began experiencing chest pains and suffered indecision. She says he’s willing to go to her local ER before the pandemic.

“It’s not something I feel very comfortable with right now,” she says. “It’s a difficult call, a difficult decision.”

Dangerous risk of postponing care

Some doctors already have a glimpse of the consequences of patients postponing treatment.

“I’ve never seen a number of delays this month or so.” Dr. Andrea Austin, An ER doctor in downtown Los Angeles.

She is now dealing with a more serious case as the patient is waiting. “It’s really one of the tragedy of COVID-19,” she says. “They’re at home, trying to diagnose themselves, or actually controlling their symptoms,” he said.

Dr. Andrea Austin is an emergency physician in downtown Los Angeles.

Sam Beckerman MD, PhD

Hide description

Switch caption

Sam Beckerman MD, PhD

Dr. Abhineet Chowdhary, a neurosurgeon at Bellevue, says some of his stroke patients already have life-changing consequences.

An old man noticed a weakness on the left side of his body, but avoided the hospital for four days.

“At the time, I couldn’t do anything to reverse the stroke at that time,” said Chowdhary. “The weakness is permanent.”

The patient was no longer able to care for his wife who had cognitive problems due to a stroke injury. In the end, the couple had to leave home and move to a nursing home.

Jennifer Kurtz, Stroke Program Coordinator at Overlake, says some patients who have delayed treatment are currently working on their physical and emotional burdens.

“They feel too guilty and regret not having come to the hospital before,” she says.

One of the caregivers confessed to Kurts because he didn’t take his husband to the hospital when he first noticed the symptoms of stroke.

“She can’t tell her daughter [that]… it’s embarrassing. “

Doctors plead “don’t be late”

In the United States, patients sometimes need to navigate messages from conflicting civil servants and interfere with everyday medical care.

Beginning in March, public health departments were investigating predictive models and warnings of floods of COVID patients spread nationwide as they deal with the worst. The story originates from health care worker hotspots like New York City and demands more personal protective equipment such as masks, gowns, and gloves.

Meanwhile, the hospital began to cancel the elective procedure, and the doctor stopped direct consultation.

The surge in COVID-19 patients at hotspots such as New York City and New Orleans has led to a “sensation of a widespread medical system with no capacity.” Dr. Biykem Bozkurt, President American Heart Failure Society Cardiologist at Baylor College of Medicine.

“This could have led to the false feeling that daily care should be postponed or that non-COVID patients were incapable. This is not the case,” Bozkurt says. “We want our patients to seek care, not to wait.”

Hospitals are also trying to reassure patients that they have taken precautions to keep them safe from infection. Many have established protocols to accept patients suspected of having COVID-19, such as individual screening areas within the ER or dedicated areas of the hospital for inpatients with coronavirus.

Dr. Tashman, an emergency physician at the USC Verdgo Hills, begs for immediate help from patients for heart attack and stroke symptoms. “Don’t delay.”

“We are not very busy doing everything else right now,” he says.

With home-based orders valid across the country, doctors are trying to balance with messaging. They still want patients to avoid hospitals, but feel free to go if there are any signs of an emergency.

“ In order for people to understand the message correctly, they need to add a little subtle nuance to the message, so just listening to one message that says you are at home can hurt you, ” said Lancaster, California emergency doctor. No, “he said. “We need to make people feel … [emergency rooms] A safe and clean place for them to come. “

This story is part of a health reporting partnership with NPR KPCC And Kaiser Health News.