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Many health centers are reporting reductions in the number of people admitted with acute coronary syndromes during the COVID-19 pandemic. The size and suddenness of the decrease have suggested that people may be avoiding the hospital to the detriment of their health (NEJM JW Cardiol Jun 2020 and N Engl J Med 2020 Apr 28; [e-pub]). Investigators from the Lombardy region of Italy sought to determine whether COVID-19 was associated with the incidence of out-of-hospital cardiac arrest (OHCA).
Within the first 40 days of the outbreak (February 21–March 31, 2020), out-of-hospital cardiac arrests were 58% higher than in the same period in the previous year. Additionally, a higher percentage of OHCAs were unwitnessed, a lower percentage involved bystander cardiopulmonary resuscitation, and a higher percentage of people died in the field.
Baldi E et al. Out-of-hospital cardiac arrest during the Covid-19 outbreak in Italy. N Engl J Med 2020 Apr 29; [e-pub]. (https://doi.org/10.1056/NEJMc2010418)
Comment
This correspondence reports a spike in OHCA in a region of Italy with a high incidence of COVID-19. Whether the increase was an indirect side effect or a direct result of the pandemic, however, remains uncertain.