Preparing for Seasonal Rise in Cardiac Events

Winter months and cold weather, more than any other time of year, pose a greater risk to people suffering from new (acute) or ongoing (chronic) cardiac events. In the Northern hemisphere, this time of year correlates with the Thanksgiving through New Year holidays2, but there are similar studies in the Southern hemisphere (Australia) where cardiac events correlate with winter peaking in July.1

(a)bout one third more deaths from ischemic heart disease were recorded in December and January4

Cold weather and the activities associated with winter weather events can result in the following conditions that may exacerbate underlying cardiac conditions, including Acute Coronary Syndrome (ACS). They include, but are not limited to:

  • Constriction of blood vessels causing increased blood pressure4
  • Higher likelihood of the formation of blood clots caused from broken plaques4
  • Physical exertion during snow, ice, or sleet removal increasing burden on heart4
  • Decreased Vitamin D caused from less access to sunshine4
  • Complications from influenza illness3
  • Increased burden on heart from other underlying respiratory issues (including wood burning fires, bronchitis from colds, etc.)4

Researchers in the US indicate that “(a)bout one third more deaths from ischemic heart disease were recorded in December and January than from June through September”.4 Cardiac conditions can also be affected by changes in diet (increasing salt intake), increased alcohol consumption, emotional and financial stress, and/or delayed treatment by people experiencing symptoms.

This means that knowing and understanding there is an increase in cardiac events during these months, facilities can be better prepared to handle these patients. The ability to triage patients to care that can reduce additional necrosis of heart muscles cells is helped by serial troponin testing of patients presenting with chest pains and suspected of having an acute coronary syndrome. Inappropriate delay in seeking medical care, the possibility that staffing levels at hospitals and other healthcare facilities may be reduced during the holiday season, and holiday on-call scheduling, which may result in staff caring for patients with whom they are less familiar, are all factors that may pose unique challenges during holiday and/or winter seasons.4

Heart-monitor-alert.jpg

 

Utilizing Troponin

 

Rapid with-patient diagnostic testing, especially troponin, may increase the overall quality of care and drive timely treatment for patients experiencing ACS. Troponin is the preferred biomarker for aiding in the diagnosis of acute myocardial infarction and an acute myocardial infarction (MI), according to guidelines from the American College of Cardiology (ACC). Troponin tests can provide early detection of the elevation cycle and predict myocardial injury with cell death in order to prevent further damage.5,6

Incorporating point-of-care serial troponin testing into standardized order sets and protocols for suspected ACS patients could lead to improved diagnostic accuracy for patients presenting with suspected acute MI. 7,8 In addition, administering point-of-care troponin testing may improve the time to result for these critical patients, and potentially decrease costs associated with traditional laboratory-based diagnostic testing.9

For more information on evidence-based approaches to diagnosis and treatment of the ACS patient, refer to ACC Accreditation Services: Guidelines for Troponin Testing

 

1. Weerasinghe, DP et al. Seasonality of coronary artery deaths in New South Wales, Australia. Heart. 2002. Vol 88. Pp 30-34. http://heart.bmj.com/content/heartjnl/88/1/30.full.pdf
2. Kam K. The Truth Behind More Holiday Heart Attacks. WebMD. https://www.webmd.com/heart/features/the-truth-behind-more-holiday-heart-attacks#1
3. Veljkovic, V et al. Influenza vaccine as prevention for cardiovascular diseases: Possible molecular mechanism. Vaccine. November 2014. Volume 32, Issue 48, Pages 6569-6575. http://www.sciencedirect.com/science/article/pii/S0264410X14009335
4. Kloner R. The “Merry Christmas Coronary” and “Happy New Year Heart Attack” Phenomenon. Circulation. 2004. 110. Pp 3744-3745. http://circ.ahajournals.org/content/110/25/3744
5. Cantu, R. Webinar. Troponin Essentials: Implementing the Guidelines. American College of Cardiology. September 2017. https://whitehatcom.com/Resources_APOC/Troponin_Essentials_R_Cantu_081817_v2.pdf
6. Brush JE et al. A Brief Review of Troponin Testing for Clinicians. American College of Cardiology. 2017. http://www.acc.org/latest-in-cardiology/articles/2017/08/07/07/46/a-brief-review-of-troponin-testing-for-clinicians
7. Sandoval et al (2017) “Diagnostic Performance of High Sensitivity Compared with Contemporary Cardiac Troponin I for the Diagnosis of Acute Myocardial Infarction” Clinical Chemistry 63:1594-1604
8. Caragher et al (2002) “Evaluation of quantitative cardiac biomarker point-of-care testing in the emergency department” Journal of Emergency Medicine 22:1-7
9. http://www.hospitalhealthcare.com/laboratories/health-economics-poct-critical-care

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