Acute cardiovascular events triggered by the COVID-19 pandemic-related stress in non-infected individuals. The Jordan COVID-19 Acute Cardiovascular Events (JoCORE) study

Abstract

The Corona Virus Disease 2019 (COVID-19) has become an unprecedented global public health crisis and a pandemic associated with vicarious psychosocial and economic stresses. Such stresses were reported to lead to behavioral and emotional disturbances in individuals not infected with the COVID-19 virus. It is largely unknown if these stresses can trigger acute cardiovascular events (CVE) in such individuals. Covid-19-neagtive adults presenting with acute myocardial infarction (AMI), cerebrovascular accident (CVA), or out-of-hospital cardiac arrest (OHCA) during the COVID-19 pandemic in Jordan from March 15, 2020 through March 14, 2021 were enrolled in the study if they reported exposure to psychosocial or economic stresses related to the pandemic lockdown. Of 300 patients enrolled (mean age 58.7 ± 12.9 years), AMI was diagnosed in 269 (89.7%) patients, CVA in 15 (5.0%) patients, and OHCA in 16 (5.3%) patients. Triggering events were psychosocial in 243 (81.0%) patients and economic stressors in 157 (52.3%) patients. The psychosocial stresses included loneliness, hopelessness, fear of COVID-19 infection, anger, and stress-related to death of a significant person. The economic stressors included financial hardships, job loss or insecurity, volatile or loss of income. Exposure to more than one trigger was reported in 213 (71.0%) patients. In-hospital mortality of the patients admitted for AMI or CVA was 2.1%, and none of the OHCA survived the event. The COVID-19 pandemic continues to be a source of significant psychosocial and economic hardships that can trigger life-threatening acute CVE among individuals not infected with the virus.

Keywords

• covid-19 pandemic
• triggered myocardial infarction
• psychosocial stressors
• cardiovascular disease
• acute cardiovascular events