Emergency heart attack and stroke centres are still here for you- Guest blog by Dr Ricardo Petraco

At Imperial College Healthcare NHS Trust, where I work as a Consultant Cardiologist, we have noticed over the past few weeks a significant reduction in the number of cases brought in by ambulances to our Heart Attack Centre (HAC). Speaking to colleagues from other hospitals in London and across the country, they are observing the same phenomenon. Numbers of heart attack and stroke cases are falling dramaticaly since the COVID-19 crisis started– perhaps more than 50-60%.

We would normally celebrate such figures – if they truly reflected a reduction in heart attack and stroke rates. But we are concerned that one of the main reasons behind such drop is that patients are too scared to call an ambulance and go to hospitals for treatments. That would mean the reason we might be seeing fewer patients with heart attacks is not that they are occurring less, but because patients are having them at home.

This is concerning for many reasons. Heart attacks are a very serious acute condition that can very rapidly lead to death if not treated promptly. We cardiologists have a very short time window of just six to 12 hours to open blocked arteries with stents. So if patients don’t come or come too late, there is nothing that can be done later. And for those who are lucky to survive, the untreated blockage leads to irreversible damage to the heart muscle, a weak heart and a condition called heart failure, which causes major debilitation for patients.

We have now learnt that across the globe in countries such as Italy and China which were hit by the coronavirus before the UK, the same trends were reported. This is also supported by some early published data from Spain, which shows that across 71 centres there was an average drop of almost 50% in angiograms and stenting procedures, which are the most effective treatments for the majority of people having a heart attack.

It is undeniable that the current coronavirus pandemic has brought unprecedented levels of pressure in the NHS, particularly to emergency services such as A&Es, ambulance services as well as heart attack and stroke units.

It is also clear that the critically important Government recommendations for social distancing and ‘lockdown’ have created a huge amount of anxiety among the public. There is a clear message to stay at home and avoid unnecessary visits to hospitals and communication with GP surgeries regarding any routine needs.

These are all essential measures which aim to halt the spread of the virus and allow our pressurised healthcare services to cope with the increased demand, because many sick patients with coronavirus need emergency care. It is also vital that we do everything we can to ensure our healthcare workers, who are risking their lives every day to save others during this pandemic, are kept as safe as possible.

However, there are a few important exceptions to the above rule. And that involves your heart and brain. If you develop a new problem with either, and you think you might be having a heart attack or a stroke – you still MUST seek help urgently. People with high cholesterol, diabetes and those with a previous history of heart conditions in particular are at a higher risk of having a heart attack or stroke and should immediately call 999 if they think they are having one. Acute cardiology and stroke units are still open and functional, and we are just as ready to treat every patient as we were before the pandemic started.

I also understand patients are worried about catching the virus in hospitals. However, let me reassure you that hospitals and other healthcare environments have all taken steps to ensure the safety of patients and staff during the COVID-19 pandemic. This includes more restrictions on contact, even stricter hygiene protocols and ‘distancing’ where appropriate as well as the standard use of protective equipment for all patients. This means that your risk of contracting coronavirus in hospital is reduced as much as possible. There are also steps you can take to reduce your risk whether you’re at home or in hospital.

So let me repeat it one more time: if you think you might be having a heart attack or stroke, you don’t need to stay at home. Call 999. As a reminder, these are the symptoms to watch out for:

The symptoms of a heart attack include:

• Pain or discomfort in your chest that doesn’t go away
• Pain that spreads from your chest to your arms, neck or jaw. Some people may just have these symptoms without chest pain or discomfort too
• Feeling sick
• Feeling clammy or sweaty
• Feeling dizzy or lightheaded
• Feeling short of breath

Think FAST for stroke:

Face – can they smile? Has their face fallen or is drooping on one side?

Arms – can they raise both arms and keep them there?

Speech – can they speak clearly and understand you? Is their speech slurred?

Time – if you see ANY of these signs it’s time to call 999[CA5] 

Let’s not allow the coronavirus pandemic to have even greater consequences and cause more unnecessary deaths because people are too worried to seek help.

We are here for you when and if you need us. You are not alone and even in these unprecedented times when the NHS is under huge strain, we can and will look after you, and I say this on behalf of all heart units across the country.

Dr Ricardo Petraco, Consultant Cardiologist, Imperial College NHS Trust