A Prospective Look at Sudden Cardiac Arrest Rates During the COVID-19 Pandemic

The rates of sudden cardiac arrest (SCA) increased during the COVID-19 pandemic, with Hispanic patients experiencing disproportionately higher increases, according to a study published in Heart Rhythm.

Investigators obtained the SCA data for this study from the PRESTO (Prediction of Sudden Death in Multi-Ethnic Communities) study, an ongoing population-based study in Ventura County, CA. The investigators identified cases of presumed SCA via a review of prehospital emergency medical services reports requiring cardiopulmonary resuscitation and/or defibrillation. These cases were reviewed by a team of study physicians. SCA was defined as a sudden, unexpected pulseless collapse of likely cardiac origin. Cases in which the etiology of the SCA was due to noncardiac causes such as trauma, drug overdose, and chronic terminal illness were excluded from the study. The investigators’ primary outcome was the incidence of SCA. The secondary outcome was survival to hospital discharge following SCA.

There were 907 cases of SCA in the 2-year pandemic period and 1315 in the 4-year prepandemic period. Demographically, during the pandemic, the proportion of SCA cases in Hispanic patients significantly increased from 24.3% to 31.6% (P <.001), while Non-Hispanic White patients accounted for a smaller proportion of cases during the pandemic. When standardized by age, the overall annual incidence of SCA increased by 38%, from 39 per 100,000 people before the pandemic (95% CI, 37-41) to 54 per 100,000 people during the pandemic (95% CI, 50-57).

Among Hispanic patients, the incidence of SCA per 100,000 people increased by 77%, from 38 to 68 per 100,000 people (95% CI, 34-43, and 95% CI, 60-75, respectively; P <.001). Among non-Hispanic patients, the incidence increased by 26%, from 39 per 100,000 people to 50 (95% CI, 37-42, and 95% CI, 46-54, respectively; P <.001). Prior to the pandemic, the SCA incidence did not differ by ethnicity (P =0.62), but during the pandemic, the SCA incidence was significantly higher among Hispanic patients than among non-Hispanic patients (P <.001).

Some limitations of the study include lack of generalizability and the method of ethnicity data collection. Patients’ race had to be pulled from death certificates rather than self-reports, creating an opportunity for bias and mistakes in data. Additionally, autopsy data are available for less than 16% of the SCA cases, indicating the possibility that other non-cardiac causes of SCA were being underreported in the study.

“The first 2 years of the COVID-19 pandemic have led to persistently higher SCA incidence, with disproportionately higher increases among Hispanic [patient]s in this population,” the study authors wrote, “These findings implicate potential ethnicity-specific barriers for access to acute care during the pandemic and represent an urgent call to action at the community as well as health-system levels.”