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Pandemic Raises NYC Cardiac Arrests and Deaths

The COVID-19 pandemic in New York City caused a surge in out-of-hospital cardiac arrests and deaths, according to a study co-authored by researchers at Einstein, Montefiore, and the Fire Department of the City of New York (FDNY).

The study, published in June in JAMA Cardiology, found a threefold increase in out-of-hospital nontraumatic cardiac-arrest cases in March and April 2020 compared with the same period
in 2019. On the worst day—April 6—cardiac arrests peaked at 305, a nearly tenfold increase compared with April 6 one year earlier. The mortality rate for cardiac-arrest cases also rose, from 75% in 2019 to more than 90% during the same period in 2020.

“The dramatic increase in cardiac arrests compared with the same period in 2019 strongly indicates that the pandemic was directly or indirectly responsible for that surge in cardiac arrests and deaths,” says the study’s senior author, David Prezant, M.D., professor of medicine at Einstein, a clinical pulmonologist at Montefiore, and the chief medical officer at the FDNY.

This graph plots the number of daily out-of-hospital cardiac-arrest resuscitations performed over the same 56-day period in 2019 (orange) and 2020 (dark blue). Source: ©2020 Lai PH et al. JAMA Cardiology

The study used data from the New York City emergency medical services system. Data were analyzed for patients 18 years or older with out-of-hospital cardiac arrest who received EMS resuscitation from March 1, 2020 (when the first case of COVID-19 was diagnosed in New York City), through April 25, 2020 (when EMS call volume had receded to pre-COVID-19 levels). For comparison, cardiac-arrest data were also analyzed for the same time period during 2019.

Between March 1 and April 25, 2020, 3,989 patients underwent EMS resuscitation attempts for out-of hospital cardiac arrests, compared with 1,336 patients who were treated during that period in 2019.

Compared with cardiac arrests in 2019, cardiac arrests occurring during the pandemic were associated with several risk factors. On average, the 2020 patients were:

  • Older (average age of 72 vs. 68 for the 2019 cardiac-arrest patients)
  • Less likely to be white (20% white vs. 33%)
  • More likely to have hypertension (54% vs. 46%)
  • More likely to have diabetes (36% vs. 26%)
  • More likely to have physical limitations (57% vs. 48%)

“Our findings show that it’s clearly important to intervene early in the course of COVID-19 infection, before cardiac arrests occur,” Dr. Prezant says.

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