COVID-19 Kills at Home: Increase in Out-of-Hospital Cardiac Arrests

Quick Takes

  • There was a 52% increase in out-of-hospital cardiac arrest (OHCA) incidence in the first 2 months of the COVID-19 pandemic in northern Italy compared to the same period in the prior year.
  • There was a strong and statistically significant correlation between the difference in cumulative incidence of OHCA between 2020 and 2019 and the COVID-19 incidence per 100,000 inhabitants.

Study Questions:

Is there an association between the out-of-hospital cardiac arrest (OHCA) and coronavirus disease 2019 (COVID-19)-related mortality?

Methods:

The authors counted the number of OHCAs occurring in a 2-month period beginning February 20, 2020 in the Provinces of Lodi, Cremona, Pavia, and Mantova following the first documented case of COVID-19 and compared them with those that occurred in the corresponding time frame in 2019.

Results:

The incidence of COVID-19 cases was 956 cases/100,000 inhabitants and the incidence of OHCA was 21 cases/100,000 inhabitants, which represented a 52% increase as compared with 2019 (490 OHCAs in 2020 vs. 321 in 2019). There was a strong and statistically significant correlation between the difference in cumulative incidence of OHCA between 2020 and 2019 and the COVID-19 incidence per 100,000 inhabitants.

Conclusions:

The increase in OHCAs in 2020 is significantly correlated to the COVID-19 pandemic.

Perspective:

The COVID-19 pandemic has wreaked havoc around the world affecting everyone, from the poor to the rich. Due to myriad factors, the rates of confirmed infections vary widely, as do confirmed mortality rates across populations. One way to assess the impact of the pandemic is to examine excess OHCAs. The present study from northern Italy suggests that they increased by a stunning 52%, which is additive to the increased mortality observed in hospitals. The increase in OHCA is likely due to a combination of respiratory failure and pulmonary embolism known to be associated with COVID-19. Other studies reported rapid progression toward acute respiratory distress syndrome, even in patients who were apparently stable a few hours earlier, a finding that comports with the acute nature of the OHCA. Other putative causes include arrhythmic sudden cardiac death due to myocardial injury, perhaps intrinsic infection-related QT interval prolongation, or one related to the administration of QT-prolonging drugs to treat the infection. There may also be indirect causes of OHCA due to the avoidance and/or delay in seeking medical care, or prolonged wait times for emergency medical services, for both COVID-19 and non-COVID conditions (acute myocardial infarction).

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Vascular Medicine, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Coronavirus, COVID-19, Death, Sudden, Cardiac, Emergency Medical Services, Heart Failure, Myocardial Infarction, Out-of-Hospital Cardiac Arrest, Pulmonary Embolism, Respiratory Distress Syndrome, Adult, Respiratory Insufficiency, Secondary Prevention, severe acute respiratory syndrome coronavirus 2


< Back to Listings