There’s anecdotal evidence that fewer people are attending A&E with the symptoms of heart attacks and strokes during coronavirus lockdown – but can it really be true?
There are two competing theories – one is that people are reluctant to attend A&E while the pandemic is in full swing for fear of infection, so they’re risking their health by not getting treatment for heart attack and stroke symptoms.
But a study in The Lancet suggests this isn’t the case.
The report by Jenny Lumley Holmes and others studied comparative numbers of ambulance call-outs in the West Midlands, the second busiest area of the NHS, last year and this year, and concluded that “The COVID-19 pandemic might be associated with negative collateral health effects, but we find no evidence that people are reluctant to call an ambulance when they experience symptoms of stroke or heart attack.”
But Dr John Wright of Bradford Royal Infirmary, while accepting this evidence, says that he has noticed fewer heart attack and stroke cases – so is there another possible explanation?
Dr Wright says: “Perhaps the slowing down of our frantic lives from our enforced lockdown, and even the cleaner air we are breathing from the reductions in traffic, are helping to keep us in finer fettle? Our slow living might be nurturing new healthier habits and lifestyles.”
There’s evidence gathered from fitness tracker apps in the USA that this might well be the case. Data from the Fitbit tracker has shown that average resting heart rates have fallen during lockdown, and while step counts have also fallen, the number of active minutes in people’s daily routines has actually risen.
The thinking is that rather than being chained to a desk in the office, people working at home are more mobile – even if it’s only going to the kitchen to make a cup of coffee.
Fitbit data also suggests that sleep duration has increased, as you would expect when people don’t have to get up early for the morning commute, then arrive home late after rush-hour.
Another suggestion, from cardiologist Prof Alistair Hall of the National Institute for Health Research, is that while they’re staying at home, people are getting more exercise and remembering to take their heart medicine.
“Cholesterol is the single biggest preventable cause of heart attacks and strokes in the world,” he says. “And I think there’s evidence suggests that during this time people are being much, much better at taking medications that otherwise they might be forgetting or missing.”
It’s not at all certain that this short-term health benefit will last – for instance our dietary habits might have changed during lockdown, and we might now be living on a diet of biscuits and microwave meals which will have a negative effect in the long term.
The British Heart Foundation website reports that if you have angina you are at high risk from coronavirus. This means if you catch coronavirus you are more likely to get seriously ill than other people who don’t have health issues.
If you’re also over 70, or also have lung or kidney disease, you’re at particularly high risk.
If your angina limits your daily life or means you frequently have to use a Glyceryl TriNitrate (GTN) spray or tablets under the tongue, or is unpredictable, you are considered to be at particularly high risk.
BHF advice is that if you are high risk or particularly high risk, you can reduce your risk of catching coronavirus by following social distancing. You don’t need to be shielding – you can leave home for essential things like food, medicine, or exercise. If you’re wondering whether to go back to work, this will depend on your individual circumstances and also whether you can socially distance if you go back to work.
If you have had open heart surgery in the last three months, you are at particularly high risk of complications from coronavirus, but if you have atrial fibrillation (AF) or another heart rhythm problem, there isn’t enough information at the moment to tell if it puts you at higher risk from coronavirus complications. It seems likely that if your atrial fibrillation is well controlled (you’re being treated for the condition and the treatment has lowered your heart rate towards the normal range), your risk will be lower.
You can find more advice about heart health at the BHF website here.
So the anecdotal evidence that fewer people are attending A&E with the symptoms of heart attacks and strokes during coronavirus lockdown may be just that, and the real story has yet to come out.