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Maryland doctors sound the alarm after seeing drop in heart attacks and strokes amid coronavirus pandemic

Cardiologists Dr. Mark Vesely and Dr. Jeremy Pollock are concerned about drops in the number of patients seeking assessment for heart, chest pain.

Since the new coronavirus began tearing through Maryland communities, doctors say they’ve seen declines in the numbers of patients showing up in emergency rooms with symptoms of heart attacks and strokes.

And that worries them.

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The number of people suffering from such symptoms likely hasn’t gone down that much, health care providers fear. Instead, they believe patients have chosen to avoid emergency room visits to their own detriment.

Some patients may worry they could contract the virus by visiting the hospital. Others may be confused by the stay-at-home orders meant to slow the spread of the COVID-19 illness.

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Whatever it is, it could jeopardize scores of heart attack and stroke victims amid an ongoing pandemic, doctors said.

“If someone is having a heart attack, the likelihood of them getting sick and dying from that is higher than them getting the virus and getting sick and dying from that,” said Dr. Mark Vesely, a cardiologist at the University of Maryland Medical Center in Baltimore. “The fear and concern many of us have is people holding back on getting the attention they need. The quicker we get them, the better people will do.”

Providers in Maryland have reported seeing below-average caseloads since the beginning of March, which some attribute to patients looking to minimize their risk of catching COVID-19 in a hospital.

But this, they said, actually increases the chance of serious health complications for stroke and heart attack victims, with the success of recovery often tied to how fast people get treated.

It remains unclear why providers have seen drops in patients seeking urgent care during the pandemic. But, Vesely, also an associate professor of medicine at the University of Maryland School of Medicine, said there could be factors other than patients wanting to avoid potentially infected spaces. With more people at home and out of work, people may be experiencing less physical stress, decreasing the chance of a significant cardiac event, he said.

Nationwide data on 911 calls shows a decrease of about 29% in call volume so far this year compared with January through April last year, according to records compiled by health care software company ESO. The data, compiled from 1,300 health agencies across the United States, also shows a 30% decrease in those calling to report chest pain and a nearly 20% drop in those calling with symptoms of a stroke.

Vesely and others said they worry that years’ worth of public messaging regarding heart health has been rendered ineffective in recent weeks, eclipsed by concerns about staying home to slow the spread of the coronavirus and orders to practice social distancing. While he said it’s important to heed these directives, he encourages patients to stay in contact with their providers and seek help if they need it.

“If you have a question, picking up your phone isn’t increasing the risk,” said Vesely, adding that the University of Maryland Medical System and other state health care providers have implemented telemedicine procedures to provide virtual care under the governor’s stay-at-home orders.

State officials said social distancing and staying at home have shown early signs of success in limiting the spread of the virus and preventing it from overwhelming the state’s health care system.

But providers said staying at home doesn’t apply to patients with symptoms of heart attack or stroke, who still need emergency treatment.

And while some individuals with heart disease can survive without urgent attention, those experiencing heart attacks — often caused by a blood clot blocking blood flow to the heart — cannot afford to dither, said Dr. Jeremy Pollock, a cardiologist at University of Maryland St. Joseph Medical Center.

Pollock said he fears a surge of patients unrelated to the coronavirus, such as those whose chronic conditions worsened by staying home and avoiding treatment, will soon challenge hospitals already facing limited staffs and space.

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“When we started planning, we wanted to take away all the patients that didn’t need to be seen,” he said. “Now, we’re seeing the back end of it.”

Patients suffering from a stroke also do not have the luxury of staying at home, said Dr. Victor Urrutia, medical director of the comprehensive stroke center at Johns Hopkins Hospital, yet declines in those reporting the symptoms have been noticeable over the past month.

Cardiologists Dr. Jeremy Pollock and Dr. Mark Vesely stand outside St. Joseph Medical Center. Maryland cardiologists have noticed drops in the number of patients seeking assessment for heart and chest discomfort since the coronavirus pandemic erupted. April 17, 2020. (Karl Merton Ferron/(Baltimore Sun Staff)
Cardiologists Dr. Jeremy Pollock and Dr. Mark Vesely stand outside St. Joseph Medical Center. Maryland cardiologists have noticed drops in the number of patients seeking assessment for heart and chest discomfort since the coronavirus pandemic erupted. April 17, 2020. (Karl Merton Ferron/(Baltimore Sun Staff) (Karl Merton Ferron/The Baltimore Sun)

“We don’t have a firm idea why the decline is, but we can, and should, treat those patients,” Urrutia said. “We’ve been in a stretch of about four to five weeks where it’s definitely decreased.”

Health care providers have the most success in treating stroke victims within about four hours of its onset, he said, though advancements in medicine have broadened the crucial time frame to about 24 hours. Beyond that, stroke victims likely will not recover fully, he added.

“People should understand, they should be taking care of themselves,” he said.

Patients who fear going into hospitals also should recognize the procedures in place designed to separate those showing COVID-19 symptoms from the rest of the patient population, said Dr. Angela Smedley, medical director of the University of Maryland Medical Center’s adult emergency department.

In addition to physically sorting and isolating potential COVID-19 patients upon arrival at the hospital, those who come via ambulance are transported in a path that minimizes direct contact with others, said Smedley, also an associate professor at the university’s medical school.

“We don’t want your first thought to be, ‘I’m afraid to go because I don’t want to infect others or because I’m afraid to get sick,' because we’ve addressed both of those things,” she said. “We have resources for you to use and COVID-19 should not stop you from using them."

Correction: A previous version of this article misspelled Dr. Victor Urrutia’s name. The Sun regrets the error.

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