Excess Cardiac Arrest in the Community During the COVID-19 Pandemic
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 COVID19 in the city during that time.
Recently, Garcia et al. and Rodriguez-Leor et al. demonstrated a 38% to 40% reduction in presentations for acute cardiac catheterization laboratory activations across a consortium of high-volume primary percutaneous intervention centers correlating with the implementation of nationwide social distancing recommendations. Multiple theories have been proposed to explain this observation, ranging from a true decrease in the occurrence of acute coronary syndromes to a response to altered ambulatory care and adherence to strict social distancing guidelines.
To evaluate this issue, we queried the Denver Health Paramedic Division database before and after the emergence of coronavirus disease-2019 (COVID-19). The Denver Health Paramedic Division is the sole emergency medical services provider for the city and county of Denver and surrounding communities. We compared the total number of ambulance activations and the number of out-of-hospital cardiac arrests (OHCAs) per week across 3 time frames related to the local outbreak: pre-mandate, January 1 until the Colorado state declaration of emergency (January 1, 2020, to March 7, 2020); peri-mandate, between the declaration of emergency and the statewide “shelter-in-place” order (March 8, 2020, to March 28, 2020); and post-mandate, the 2-week period following the implementation of shelter-in-place practice (March 29, 2020, to April 11, 2020). Finally, we compared the post-mandate period with historical data for the corresponding period between 2011 and 2019. The study was approved by the Denver Health ethics committee. Comparisons were made using analysis of variance with Fisher post hoc testing.