COVID-19 Pandemic Dramatically Increased Out-of-Hospital Cardiac Arrest Cases and Deaths in New York City

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 Albert Einstein College of Medicine, Montefiore Health System, and the Fire Department of the City of New York (FDNY).

The study, published online today in JAMA Cardiology, found a three-fold increase in out-of-hospital non-traumatic cardiac-arrest cases in March and April 2020 compared to the same period in 2019. On the worst day— April 6—cardiac arrests peaked at 305 cases, an increase of nearly 10-fold compared with the same day one year earlier. The mortality rate for cardiac-arrest cases also rose, from 75 percent in 2019 to more than 90 percent during the same period in 2020.

"Relatively few, if any, patients were tested to confirm the presence of COVID-19, so we couldn't distinguish between cardiac arrests attributable to COVID-19 and those that may have resulted from other health conditions," said study senior author David Prezant, M.D., professor of medicine at Einstein, a clinical pulmonologist at Montefiore, and the Chief Medical Officer at the FDNY. "We also can't rule out the possibility that some people may have died from delays in seeking or receiving treatment for non-COVID-19-related conditions. However, the dramatic increase in cardiac arrests compared to the same period in 2019, strongly indicates that the pandemic was directly or indirectly responsible for that surge in cardiac arrests and deaths." 

The study used data from the New York City emergency medical services system. Run by the FDNY, it is the largest and busiest EMS system in the U.S., serving a population of more than 8.4 million people and responding to more than 1.5 million calls annually. Data was 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 was 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 to 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 percent white vs. 33 percent)

• More likely to have hypertension (54 percent vs. 46 percent)

• More likely to have diabetes (36 percent vs. 26 percent)

• More likely to have physical limitations (57 percent vs. 48 percent)

• More likely to have cardiac rhythms that don't respond to defibrillator shocks (92% vs. 81%)

• More likely to die (90% vs 75%)

Why might a respiratory disease like COVID-19 trigger heart problems? In addition to overwhelming pneumonia and acute respiratory failure, COVID-19 damages the lining of blood vessels, leading to blood clots that can trigger heart attacks even in people with no previous cardiopulmonary diseases.

"Our findings show that it's clearly important to intervene early in the course of COVID-19 infection, before often-fatal cardiac arrests occur," said Dr. Prezant. "They also underline the critical need, particularly during a pandemic, to provide better access to healthcare and outreach for vulnerable patients with chronic conditions. Early, targeted interventions for those at-risk individuals—regular telemedicine visits and home-based monitoring of vital signs including oxygen saturation levels, for example—might help to reduce out-of-hospital fatalities."

The study is titled "Characteristics Associated With Out-of-Hospital Cardiac Arrests and Resuscitations During the Novel Coronavirus Disease 2019 Pandemic in New York City." Other authors are: Pamela H. Lai, M.D., Ph.D., M.Sc., and Elizabeth A. Lancet, Dr.P.H. M.P.H., from FDNY; Michael D. Weiden, M.D. M.S., from FDNY and NYU Langone; and Mayris P. Webber, Dr.P.H. M.P.H.; Rachel Zeig-Owens, Dr.P.H., M.P.H.; and Charles B. Hall, Ph.D., all from Einstein-Montefiore and FDNY.

About Albert Einstein College of Medicine
Albert Einstein College of Medicine is one of the nation's premier centers for research, medical education and clinical investigation. During the 2019-20 academic year, Einstein is home to 724 M.D. students, 158 Ph.D. students, 106 students in the combined M.D./Ph.D. program, and 265 postdoctoral research fellows. The College of Medicine has more than 1,800 full-time faculty members located on the main campus and at its clinical affiliates. In 2019, Einstein received more than $178 million in awards from the National Institutes of Health (NIH). This includes the funding of major research centers at Einstein in aging, intellectual development disorders, diabetes, cancer, clinical and translational research, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Einstein runs one of the largest residency and fellowship training programs in the medical and dental professions in the United States through Montefiore and an affiliation network involving hospitals and medical centers in the Bronx, Brooklyn and on Long Island.

About Montefiore Health System
Montefiore Health System is one of New York's premier academic health systems and is a recognized leader in providing exceptional quality and personalized, accountable care to approximately three million people in communities across the Bronx, Westchester and the Hudson Valley. It is comprised of 11 hospitals, including the Children's Hospital at Montefiore, Burke Rehabilitation Hospital and close to 200 outpatient care sites. The advanced clinical and translational research at its medical school, Albert Einstein College of Medicine, directly informs patient care and improves outcomes. From the Montefiore-Einstein Centers of Excellence in cancer, cardiology and vascular care, pediatrics, and transplantation, to its preeminent school-based health program, Montefiore is a fully integrated healthcare delivery system providing coordinated, comprehensive care to patients and their families. 

The Fire Department of the City of New York (FDNY) is the largest Fire Department in the United States and universally is recognized as the world's busiest and most highly skilled emergency response agency. The Department's main goal is to provide fire protection, emergency medical care, and other critical public safety services to residents and visitors in the five boroughs. The Department also works to continually educate the public in fire, life safety and disaster preparedness, along with enforcing public safety codes. Since its inception in 1865, FDNY has helped lead efforts to make New York the safest big city in the nation. This accomplishment requires a steadfast and daily commitment to maintaining the Department's core values. To that end, FDNY members are sworn to serve and protect life and property. FDNY not only responds to more than a million emergencies every year, its personnel also strive to prevent them by continually educating the public in fire, life safety and disaster preparedness, along with enforcing public safety codes.