Elsevier

Heart Rhythm

Volume 20, Issue 7, July 2023, Pages 947-955
Heart Rhythm

Clinical
Sudden Death
Sudden cardiac arrest during the COVID-19 pandemic: A two-year prospective evaluation in a North American community

https://doi.org/10.1016/j.hrthm.2023.03.025Get rights and content

Background

Early during the coronavirus disease 2019 (COVID-19) pandemic, higher sudden cardiac arrest (SCA) incidence and lower survival rates were reported. However, ongoing effects on SCA during the evolving pandemic have not been evaluated.

Objective

The purpose of this study was to assess the impact of COVID-19 on SCA during 2 years of the pandemic.

Methods

In a prospective study of Ventura County, California (2020 population 843,843; 44.1% Hispanic), we compared SCA incidence and outcomes during the first 2 years of the COVID-19 pandemic to the prior 4 years.

Results

Of 2222 out-of-hospital SCA cases identified, 907 occurred during the pandemic (March 2020 to February 2022) and 1315 occurred prepandemic (March 2016 to February 2020). Overall age-standardized annual SCA incidence increased from 39 per 100,000 (95% confidence [CI] 37–41) prepandemic to 54 per 100,000 (95% CI 50–57; P <.001) during the pandemic. Among Hispanics, incidence increased by 77%, from 38 per 100,000 (95% CI 34–43) to 68 per 100,000 (95% CI 60–76; P <.001). Among non-Hispanics, incidence increased by 26%, from 39 per 100,000 (95% CI 37–42; P <.001) to 50 per 100,000 (95% CI 46–54). SCA incidence rates closely tracked COVID-19 infection rates. During the pandemic, SCA survival was significantly reduced (15% to 10%; P <.001), and Hispanics were less likely than non-Hispanics to receive bystander cardiopulmonary resuscitation (45% vs 55%; P = .005) and to present with shockable rhythm (15% vs 24%; P = .003).

Conclusion

Overall SCA rates remained consistently higher and survival outcomes consistently lower, with exaggerated effects during COVID infection peaks. This longer evaluation uncovered higher increases in SCA incidence among Hispanics, with worse resuscitation profiles. Potential ethnicity-specific barriers to acute SCA care warrant urgent evaluation and intervention.

Keywords

Bystander cardiopulmonary resuscitation
COVID-19
Ethnicity
Hispanic
Pandemic
Sudden cardiac arrest

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Funding Sources: This work is funded, in part, by National Institutes of Health, National Heart, Lung, and Blood Institute Grants R01HL145675 and R01HL147358 to Dr Chugh. Dr Chugh holds the Pauline and Harold Price Chair in Cardiac Electrophysiology at Cedars-Sinai. The funding sources had no involvement in the study design; or in the collection, analysis, and interpretation of the data; or in the decision to submit for publication. Disclosures: The authors have no conflicts of interest to disclose.

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