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Omaha-area hospitals see big drop in stroke, heart attack patients amid coronavirus

Omaha-area hospitals see big drop in stroke, heart attack patients amid coronavirus

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Omaha-area health systems have seen a dramatic decrease in the number of heart attack and stroke patients coming through their doors since the coronavirus pandemic began.

A review of cases, published last week in the New England Journal of Medicine, found a 39% decrease in patients undergoing stroke imaging from February to a period between late March and early May. And a survey of nine major hospitals last month showed that the number of severe heart attacks being treated in U.S. hospitals had dropped by nearly 40% since the novel coronavirus took hold in March.

Local cardiologists and neurologists say they’re seeing similar — in some cases larger — decreases in patients seeking evaluation and care for the two conditions, both of which are leading causes of death and disability. Some also are noticing patients coming in later, hours or even days after their attacks.

The exception so far has been CHI Health, which has seen no decline in strokes overall and since February has seen an increase in big strokes involving large blockages requiring a procedure that involves fishing the clot out of the blood vessel.

Doctors so far don’t have a concrete explanation for why many hospitals are seeing fewer patients for strokes and heart attacks. But a leading theory is that people are waiting out their symptoms at home because they’re afraid to come to the hospital and risk exposure to the virus.

Doctors are concerned that such delays could mean missing out on time-sensitive treatment and result in long-term damage and disability.

“Everyone is struggling to understand why the drop is happening,” said Dr. Pierre Fayad, a neurologist and medical director of the Nebraska Medical Center’s stroke center. “But the biggest fear is that patients are missing out because of fear. Fear shouldn’t stop them from seeking care.”

Health care officials, in fact, are reminding people that it’s safe to call 911 if they’re experiencing symptoms of either type of attack and safe to come to hospitals for emergency treatment. Some hospitals also are seeing people putting off seeking care for other emergencies, such as appendicitis and gallbladder troubles.

Leaders of the American Heart Association and seven other national heart and stroke groups posted a letter to that effect last month.

Locally, doctors stressed that area hospitals have implemented a number of measures intended to keep staff and patients safe from the virus, including requiring patients and providers to wear masks and barring visitors in most cases. Patients with suspected COVID-19 typically are evaluated and treated in separate areas.

“You need to take your heart attack seriously and get it managed and let us protect you from the virus,” said Dr. Daniel R. Anderson, a Nebraska Medicine cardiologist and chief of cardiovascular medicine at the University of Nebraska Medical Center.

Area hospitals also have the capacity needed to treat patients with conditions other than COVID-19. Hospitals and surgical centers in the Omaha area canceled most elective surgeries and procedures from mid-March to early May in order to prepare for a virus surge.

But since Gov. Pete Ricketts lifted restrictions effective May 4 for those hospitals that had adequate beds and protective gear, they have slowly begun to add those procedures. St. Francis Hospital in Grand Island and Good Samaritan in Kearney, both of which have had surges in COVID-19 patients, reopened for nonurgent procedures Tuesday after meeting the mark for capacity.

Fayad said the overall number of people arriving at the Nebraska Medical Center for strokes is down by about 30% on average. Smaller hospitals are seeing declines as well, as evidenced by a 50% reduction in calls through the health system’s telehealth network. That system connects the health system with 10 sites in Nebraska and Iowa for remote stroke consultations.

Those who are coming in typically have more severe symptoms, he said. And some have waited for hours or even days. Similar reports of such delays have come in from New York, South Carolina and Florida.

Treatments developed in recent years can reverse stroke and heart attack effects. But they need to be administered quickly.

“There’s no other explanation for a trend like this,” Fayad said. “We’ve never seen this kind of drop before.”

Dr. David Franco, a neurologist and stroke director at Methodist Hospital and Methodist Women’s Hospital, said the number of patients coming in for stroke evaluation was down about 50% from March through early May compared with the same period last year.

Pam Stout, stroke program coordinator for Methodist Health System hospitals in Omaha and Council Bluffs, said the hospitals are seeing the stroke patients who do come in show up later. Staff have heard patients say that they didn’t want to come in because they thought the hospitals were busy with the virus or because they didn’t want to catch it.

Dr. Vishal Jani, medical director for stroke with CHI Health in Nebraska and Iowa, said the health system initially saw a 10% to 15% decline in patients coming in to get checked for stroke. But those numbers now are running head to head with the same months last year.

CHI has seen an increase in the number of patients with large-vessel blockages requiring the vessel-clearing procedure known as mechanical thrombectomy. It’s a relatively rare intervention, used in about 5% of stroke patients. Typically, he and his team do four or five a month. Since April, they have been performing nearly twice as many, peaking at 11 in April. That increase is consistent with a trend seen in hard-hit New York City. Both here and there, such patients tend to be younger.

COVID-19 has been associated with increased clotting, thought to be part of the body’s infection-fighting response to the virus. But CHI Health hasn’t seen many patients diagnosed with COVID-19 experiencing large-vessel clots, Jani said.

Research so far indicates that it can take from eight to 12 days for people who have been exposed to the virus to suffer strokes. Jani said his theory is that some patients may be suffering strokes before they test positive.

“That could be the reason, but we can’t be sure,” said Jani, an assistant professor of neurology with Creighton University’s School of Medicine. He served on an international panel that prepared guidelines for safely treating COVID-19 patients for stroke during the pandemic.

Cardiologists across all three systems are seeing decreases in patients coming in for evaluation of heart symptoms.

Anderson, the Nebraska Medicine cardiologist, said he has seen a 60% decrease in April compared with the first three months of 2020. Methodist has seen declines similar to those it has seen for stroke.

Dr. Jeffrey Carstens, a cardiologist with CHI Health, said the system’s heart visit numbers in Omaha and Lincoln are down by as much as 40%.

“You typically don’t want to make too much of a blip in a number,” he said, comparing it to the stock market. “But it’s so consistent with what we’re seeing nationally that it has to be real.”

It could be that people are having fewer heart attacks because they’re less active or facing less social stress while isolating at home, he said. Some also may be misinterpreting their symptoms.

But some are waiting it out at home, which means they arrive when they’re sicker and harder to treat.

“If you think you need to come, you just need to come,” Carstens said. “It’s important to get checked out if you think there’s something wrong.”

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Julie Anderson is a medical reporter for The World-Herald. She covers health care and health care trends and developments, including hospitals, research and treatments. Follow her on Twitter @JulieAnderson41. Phone: 402-444-1066.

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