When the new coronavirus first swept through Colorado earlier this year, baffling doctors with its myriad of symptoms and methods of spread, Dr. Brian Stauffer, the head of cardiology at Denver Health, soon began to notice a different kind of pandemic mystery.
People, it seemed, had stopped having heart attacks.
At Denver Health and other large hospitals across the metro area, the number of people showing up with cardiac emergencies dropped significantly as the state imposed increasingly strict measures encouraging people to stay at home to slow the virus’ spread. And this was not unique to Colorado — hospitals across the country and in Europe documented the same phenomenon. Had stay-at-home orders somehow also slowed heart attacks or were people in need of medical help simply not seeking it for fear of COVID-19?
A new study from Stauffer and several Denver Health colleagues offers the first clue to the answer in Colorado. Looking at data on ambulance calls in Denver, they found that, while overall calls for service went down during the stay-at-home period, the number of people dying from cardiac arrests at home shot up.
Stauffer’s team found that cardiac arrests at home in Denver more than doubled in the two weeks after the statewide stay-at-home order was issued compared with historical averages. Even compared with more recent data, the weekly average of out-of-hospital cardiac arrests jumped to 46 during those two weeks, versus 26 or 27 in the three months prior.
Stauffer and his colleagues found that the number of people in Denver who died of cardiac arrests at home in the two weeks following the statewide stay-at-home order was greater than the total number of people who died of COVID-19 in the city during that time.
“It was pretty profound the difference that we saw in 2020 in the setting of COVID compared to the prior years,” Stauffer said.
The findings add significant insight to the question of “excess deaths” during the pandemic.
Colorado, like many other states, has seen a rise in deaths during the time of COVID-19 that is above and beyond what can be explained just by documented deaths due to the virus or by population growth. April, for instance, was likely the deadliest month in Colorado history. While coronavirus has killed more than 1,700 people in Colorado this year, deaths due to cancer, heart disease and drug overdose are also on the rise.
Leading causes of death in Colorado in 2020*:
1. Cancer, 4,318 deaths
2. Heart disease, 4,095 deaths
3. COVID-19, 1,377 deaths
4. Chronic lower respiratory diseases, 1,363 deaths
5. Cerebrovascular diseases, 1,136 deaths
6. Alzheimer’s disease, 1,128 deaths
7. Unintentional injuries excluding drug overdoses, 1,124 deaths
8. Suicide, 580 deaths
9. Diabetes, 563 deaths
10. Chronic liver diseases, 527 deaths
* Numbers are as of July 27 and are preliminary, meaning they could increase as more data becomes available.
Source: Colorado Department of Public Health and Environment
Stauffer said it is possible that some of the cardiac arrests during the stay-at-home period were the direct result of coronavirus infection. Few of the deaths resulted in autopsies, he said, and testing for the virus at the time was still quite limited — so it’s possible some were undiagnosed COVID-19 cases.
But he doesn’t think that’s the predominant explanation. Instead, he said it’s more likely that people who were having heart attacks tried to brush them off to avoid going to the hospital. Without treatment, that would lead to damage in their hearts that would cause a cardiac arrest.
“People tend to downplay things under normal circumstances and then, when they’re afraid to go to the hospital, they tend to downplay them even more,” Stauffer said.
This explanation for the data is still a hypothesis, though. Stauffer said work is ongoing to dig deeper into the individual case histories of those who died to learn more about what happened.
But Stauffer and his colleagues argue in their study that their findings need to be considered when thinking about future coronavirus restrictions and “the unintended consequence of the pandemic response in the context of chronic and emergent cardiovascular disease.”
Meanwhile, Stauffer said the volume of cardiac patients at Denver Health is just about back to normal. But he’s noticed another trend: Those who are coming into the hospital now are sicker than patients pre-pandemic.