Hospitals are busy right now, as physicians, nurses and other professionals work to treat COVID-19 patients and test for the highly transmissible virus. However, other parts of the hospitals are much quieter, especially cardiology departments.
These healthcare systems in Arkansas and across the world are scrambling to contain the ongoing COVID-19 pandemic, which is steadily growing in cases day-by-day. Hospitals are ordering personal protective equipment, creating isolation units and reassigning staff in order to deal with the unique challenges that the virus presents.
In the meantime, some of the most common health conditions are seemingly missing from hospitals. Some doctors are even wondering, “Where have all the heart attacks gone?”
The case of the missing heart attacks has been a major cause of concern for Dr. Bruce Murphy, the president and CEO of Arkansas Heart Hospital. As any good detective knows, a problem cannot always be boiled down to one cause.
Heart attacks, strokes and other heart issues have obviously not disappeared overnight. Murphy suggests that one cause of the downturn in heart patients has been a fear on the part of patients to get out and go to the hospital during the pandemic.
“I don’t think that the incidence of coronary diseases is changing, and I don’t think necessarily that the symptoms are changing. But it may well be that with the mild, moderate preliminary symptoms that people in the past were coming to see a doctor for, they simply are too scared to get out and are not presenting with the early symptoms,” Murphy said.
Murphy isn’t alone in this assessment. In a New York Times article, Yale-New Haven Hospital cardiologist Dr. Harlan Krumholz wrote that cardiology and many other health departments in hospitals across the nation and the world are experiencing a shortfall of patients to treat for these common ailments.
“The most concerning possible explanation is that people stay home and suffer rather than risk coming to the hospital and getting infected with coronavirus. This theory suggests that COVID19 has instilled fear of face-to-face medical care,” Krumholz wrote.
Patient volume has dropped by half at Arkansas Heart Hospital. In an average month, Murphy estimates that there are roughly 1,000 patients in the emergency room, but the hospital is currently tracking for around 450 to 500 for this month.
This presents a longer-term problem for heart patients who ignore early or mid-stage warnings. The later patients wait, when it comes to heart disease, the more severe complications they are likely to have, according to Murphy.
Bruce Murphy presents the testing kit to Dr. Naveen Patil, of the Health Department.
There have also been fewer procedures being done for heart patients, including at Arkansas Heart Hospital. At both the federal and state level, hospitals have been directed to cease performing elective surgeries for patients. As early as March 14, U.S. Surgeon General Dr. Jerome Adams recommended that hospitals suspend elective surgeries.
On April 3, Arkansas Department of Health Secretary Dr. Nathaniel Smith issued a directive on elective surgeries, ordering healthcare facilities to “prioritize urgent and emergency visits and procedures for the coming several weeks.” Under this directive, health-care facilities are required to reschedule procedures, testing and office visits that can be safely postponed. There are exceptions to the directive, including if there is a threat to a patient’s life or function if a given procedure is not performed, or if there is a risk of a disease/condition progressing in severity if a procedure is not performed.
This order to suspend elective surgeries is even affecting heart patients. “Despite the fact that most people would say that heart disease is an acute emergency, and it is, most of our patients are actually elective and get elective workups. Because we have stopped doing elective workups, our overall volumes are down,” Murphy said.
Meanwhile, Murphy donated an Abbott ID Now COVID-19 testing device to the Arkansas Department of Health for use with state health-care workers who have been exposed tothe virus.
The fear of contracting the COVID-19 virus and suspension of elective surgeries will have negative impacts, Murphy predicts. Heart disease is the No. 1 killer in Arkansas as well as the entire United States. The Centers for Disease Control estimates that approximately 647,000 Americans die as a result of heart disease annually – a rate of one in four deaths.
Heart disease has an even higher prevalence in Arkansas compared to most of the U.S. The national average for heart disease is 3.4 percent for females and 5.2 percent for men, according to the United Health Foundation’s health rankings. Arkansas’ rate of heart disease is 5.3 percent for women and 7.6 percent for men.
“Patients that have chronic diseases are not being treated and are certainly going to suffer because of that,” Murphy said. “Those patients who have a chronic or acute illnesses that need our help far outweigh the potential death rate from the COVID-19 patients in Arkansas, specifically heart disease per year. Heart disease will kill far more patients than the models predict that will die from COVID-19.”
COVID-19 isn’t just having an impact on heart patients but on the departments themselves. While hospitals are seemingly busier than ever, there have been staff furloughs across the nation, including in Arkansas hospitals.
“The consequences of all that is that there are a lot of idle health-care workers and there are a lot under-employed health-care workers right now that hospitals simply can’t sustain. No hospital can simply sustain having people stand around idle,” Murphy said.
In Arkansas Heart Hospital’s case, the health system has adapted by adding a 28-bed respiratory intensive-care unit. This unit was added virtually overnight in order to meet demand caused by the pandemic.
Hospitals, like Arkansas Heart Hospital, are continuing to see and treat patients, but nowhere near as many as before the pandemic struck. Murphy is holding out hope that the crisis will abate in the coming weeks so that more patients will feel comfortable with returning to health-care facilities.
“I don’t think it’s going to go back to the previous volume of patients that we were seeing, but I do in fact think that over the next few weeks, people are going to adapt to the situation and get more used to the situation. And then hopefully the situation will diminish as this horrible virus burns itself out.”
Cardiologists can then get back to business – treating heart attacks and strokes – instead of COVID-19.
