Heart attacks outside of hospitals increased, were deadlier during pandemic (By: Stephanie Soucheray, MA)

Today in JAMA Network Open, a new study shows that the incidence of out-of-hospital cardiac arrest (OHCA) increased during the  pandemic, and survival decreased. Rather than being directly linked to acute COVID-19 infections, the authors said the changes were linked to emergency medical services (EMS) use during the pandemic.

The findings were based on OHCA among adults attended by EMS in Seattle and King County, Washington, from January 1, 2018, to December 31, 2021.

During the study period, there were 13,081 EMS-attended patients with OHCA, 7,102 (54%) of whom were dead on arrival (DOA) and 5,979 (46%) of whom received attempted resuscitation. The average age was 64 years, and 64.6% were men.

“Of the 5,979 EMS-treated cases, 2,837 occurred during prepandemic years and 3,142 occurred during pandemic years, representing a 10.8% increase,” the authors said. “We also observed a 27.2% increase in EMS-attended DOA patients, from 3,126 during prepandemic years to 3,976 during the pandemic period.”

Indirect pandemic factors at play

Only 194 patients (6.2%) during the pandemic years were acutely infected with SARS-CoV-2.

According to the authors, however, there were lower proportions of OHCA survival outcomes during the pandemic compared with the prepandemic period, including survival to hospital admission (1,122 patients [35.7%] vs 1,209 patients [42.6%]), survival to hospital discharge (483 patients [15.4%] vs 544 patients [19.2%]), and survival with favorable neurologic status (432 patients [13.7%] vs 489 patients [17.2%]).

The findings suggest that a substantial proportion of the increase in OHCA incidence and the decrease in OHCA survival was not due specifically to acute COVID-19.

The unadjusted odds ratio of survival to hospital discharge during the pandemic period compared with the prepandemic period was 0.77 (95% confidence interval, 0.67 to 0.88).

“The findings suggest that a substantial proportion of the increase in OHCA incidence and the decrease in OHCA survival was not due specifically to acute COVID-19, but rather indirect factors that more generally challenged OHCA prevention and treatment,” the authors concluded.