You are not “Safer at Home” If You’re Having a Heart Attack

You are not “Safer at Home” If You’re Having a Heart Attack
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Heart disease did not disappear when coronavirus arrived. Every day, Americans need urgent care in hospitals for serious heart conditions. We have spent years educating the public on recognizing and responding quickly to heart attacks and strokes. Either the COVID-19 pandemic miraculously cured heart disease or heart patients are not coming to the hospital now. I am all for the “Shelter in Place” orders but I am concerned the public has taken this message too far at their own risk. I can understand why. The cognitive dissonance of empty emergency departments and hospital beds in a once in a lifetime pandemic is mind-boggling.  

Conservatives and liberals are engaged in a Twitter war centered on #FilmYourHospital. People are driving by their local hospitals and taking video to prove the media is spreading fake news about overrun hospitals with patients being kicked off ventilators. Liberals are flooding threads with their own videos of New York and New Orleans hospitals bursting at the seams and trucks lining up to take dead bodies to the morgue. I can end this right now: Both are correct. America is a big country and this virus will be hitting our communities on its own schedule. So, can we stop politicizing this crisis now?

Ironically despite war-like conditions in some cities, many hospitals across the US are like ghost towns with floors of empty beds. Shelter-in-place orders, postponed elective surgeries, and fear of going to the hospital have emptied these hospitals. This is prudent. But well-meaning patients worry that going to the hospital will take a much-needed bed for COVID patients who are not there yet. We may have gone too far with this messaging. Patients that need to go to the hospital still need to go. Time saves lives. Unfortunately, patients are doing everything they can to avoid or delay coming to hospitals, risking their own health.  Pandemic or not if you have signs and symptoms of a heart attack or stroke call 911.  Unless you live in a COVID hotspot you will be greeted and treated swiftly at a half full emergency department.

Signs and symptoms of a heart attack can include chest pain or tightness, pain radiating down your arm or into your jaw, shortness of breath and nausea, fatigue and sweating or dizziness.  We used to think women were more likely to present with atypical symptoms, but the VIRGO study published in Circulation on February 20 2018 demonstrated young men and women presented with similar symptoms.  For stroke, remember the acronym FAST for facial drooping, arm weakness, speech difficulties, time to call 911.

We should use telemedicine and virtual visits to keep patients out of the hospital when possible, but patients having acute heart attacks can save critical heart muscle by getting to a cardiac catheterization lab ASAP after they develop symptoms. Stroke patients can also minimize brain injury by getting to a hospital and receiving clot-busting medication or procedures as quickly as possible. Cardiologists are using Twitter to discuss the record low numbers of patients coming for care and debating why. Are locked in people being less active, leading to fewer problems? Are they changing their diets? Or more likely are they just not coming in at all? Those that do come in appear to be coming in later in their disease process and this will lead to them having greater long-term heart damage. Delaying care now will likely cause a wave of patients coming later with more complicated cases at the very time the COVID cases will peak in our communities.

Hospitals, surgery centers and physician practices have been forced to cut hours, cut pay and furlough employees even as New York and other besieged cities are desperately short staffed and overwhelmed. We need to nuance the message and the cancellation of elective surgeries. Communities with little to no COVID patients with hospital capacity and adequate PPE, should be allowed to continue the most necessary elective procedures. Should any one of those conditions change the surgeries can be stopped immediately. This will help save many lives and jobs and keep rural hospitals from closing. One size fits all really fits no one. 

After years of improving care and education, mortality for heart disease and stroke has declined. The media should emphasize that shelter-in-place does not apply when time-sensitive treatment is needed. I fully support all the “Shelter in Place” and “Stay at Home” orders. But I am afraid the word “Lockdown” may keep patients from getting the care they need. We will need to be nuanced and take a holistic view on all aspects of our messaging until we are safe again.

Dr. Dennis Deruelle, MD, FHM, practicing Hospitalist and author of Your Health care Playbook, Winning the Modern Game of Medicine.

 

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