Hospitalization rates for acute myocardial infarctions (AMIs) (aka, heart attacks) in the traditional Medicare population fell 20% during the COVID-19 period. In June 2023 there were 0.044 AMI hospital encounters per 100 patients compared to 0.055 per 100 patients in June 2019. 

A recent study in JAMA Cardiology by Andrew Wilcock, José Zubizarreta, and colleagues investigated possible explanations behind this significant drop including whether patients avoided the hospital for treatment due to fear of COVID-19 infection, excess mortality from COVID-19 among patients who would otherwise have had an AMI, a reduction in the incidence or severity of AMIs due to pandemic-related changes in behavior, or a preexisting temporal trend of lower AMI incidence.

The analysis revealed several factors and refuted others. Early in the pandemic, patterns of AMI hospitalizations were consistent with a patient avoidance of the hospital story. Later in the pandemic, after the omicron wave of COVID-19 subsided in April 2022, hospitalizations returned to a pre-existing downward trend in incidence, which continued through the end of the pandemic period in 2023. Changes in the composition of patients, either from excess death or enrollment, could not explain the patterns they observed.

Several implications can be drawn from these findings. First, the study underscores the importance of considering both short-term and long-term trends when analyzing healthcare outcomes during and after public health crises. Second, it highlighted the contributions that lifestyle changes (eg, not smoking), improved access to care, and advancements in preventative procedures have played in lowering AMI incidence over the past 30 years, and which continue to drive lower rates. Finally, the study emphasized the importance of effective communication and public health messaging (for all conditions) to encourage timely healthcare seeking during challenging times like a global pandemic.