Tag Archives: ‘distressing’

‘Distressing’ drop in people seeking care for heart attacks in Canada, data suggests

New data suggests fewer people in Canada are seeking care for serious heart attacks amid the COVID-19 pandemic.

Heart & Stroke and the Canadian Cardiovascular Society analyzed data from Ontario cardiac centres and found an unusually low number of people turning up at the hospital with the most serious type of heart attack, known as a STEMI.

They found a nearly 30 per cent drop in emergency department visits between March 16 and April 12 compared to the same period last year. Vancouver Coastal Health saw an approximately 40 per cent drop in STEMI patients during a similar time period.

Researchers say it’s unlikely the number of serious heart attacks has suddenly plummeted. They worry heart patients are at risk of greater disability or death because they may be avoiding care for fear of being exposed to COVID-19.

WATCH | Doctors worry about dramatic drop in ER visits across Canada:

Concerns about COVID-19 are stopping people from going to the emergency room with other conditions, including heart attacks and strokes. 1:58

Society president Dr. Andrew Krahn called the findings “distressing” and urged anyone with signs of heart attack and stroke to seek immediate medical attention.

Krahn said the empty emergency departments are a worry for health-care providers like him because they don’t mean people are well. Rather, they mean people are staying home who need urgent medical attention for a variety of reasons.

“I’m talking about heart conditions,” Krahn said. “But we know for instance there are more patients who are suffering strokes at home and don’t come to attention. And kidney failure where they come in and by the time they get in they need dialysis.”

He said the health-care system has precautions in place to test people for COVID-19 and to protect patients, and that it is prepared to respond to life-threatening medical issues during the pandemic.

Anne Simard, chief mission and research officer at Heart & Stroke, says anyone living with a chronic condition such as high blood pressure, heart disease or stroke with new or worsening symptoms should seek urgent medical treatment.

“We know everyone is concerned given the pandemic, but if these other serious issues are not treated and managed, people can become critically ill or worse,” Simard said in a release.

The signs of stroke can be remembered with the FAST acronym:

  • Is the Face drooping?
  • Can you raise both Arms?
  • Is Speech slurred or jumbled?
  • If so, it’s Time to call 911.

Signs of a heart attack include chest pressure, squeezing, fullness or pain; sweating; discomfort in the neck, jaw, shoulder, arms, or upper back; nausea; shortness of breath; and light-headedness.

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Nursing home residents with advanced dementia often face ‘distressing’ transfers, MDs find

If everyone was more aware of dementia, it could improve comfort in a loved one’s dying days, say Canadian geriatricians who found distressing medical procedures were common among nursing home residents, especially men.

The geriatric researchers published a study Friday in the journal JAMA Network Open on 27,000 nursing home residents in Ontario with advanced dementia who died. They focused on differences between men and women in receiving “burdensome interventions” in the last month of life. These included transfers to an emergency department to be mechanically ventilated and other invasive treatments.

While people with early-stage dementia can understand and communicate their needs, those in an advanced stage have profound memory impairment and are often unable to walk or recognize family members and may need help to eat, dress, groom and bathe.

Dr. Nathan Stall led the research, which he hopes will guide better care for frail, vulnerable older adults with advanced dementia.

“It really can be psychologically distressing for these individuals to be transferred out of their home to a foreign environment where all sorts of invasive things are happening to them,” said Stall, a geriatrician and research fellow at Women’s College Research Institute in Toronto. “It’s thinking about how can we improve the quality of life for these people at the end of life.”

When physicians and family members of people with dementia are asked what the goal of care should be at the end of life, more than 90 per cent say quality of life, he said.

In the last 30 days of life, the researchers’ findings included:

  • One in 10 nursing home residents visited a hospital emergency department.
  • One in seven died in an acute-care facility.
  • One in four were physically restrained.

Persistent sex difference

What was striking, Stall said, were the sex-based differences.

Almost 29 per cent of male residents were hospitalized in the last 30 days of life, compared with 19 per cent of women. About 11 per cent of men visited emergency departments, compared with eight per cent of women. Antibiotics were given to 41 per cent of men, compared with 34 per cent of women.

It’s well documented that women are less likely than men to be offered invasive procedures earlier in life, such as a knee replacement, Stall said. The difference persists at end of life despite the care no longer being optimal, he added.  

Most physicians and family members caring for individuals with advanced dementia favour palliative care, previous research suggests. (Nicole Ireland/CBC)

For Stall, the next step is to improve awareness about the terminal prognosis of advanced dementia and complications such as aspiration —  having food or saliva go into the lungs that can land a patient in hospital.

Calm environment

Study co-author Dr. Paula Rochon, vice-president of research at Women’s College Hospital, said geriatricians are an important resource to help families think about difficult questions about end of life wishes early on with families. Dementia disproportionately affects women.

Beth Kallmyer, vice-president of care and support for the Alzheimer’s Association in Chicago, manages a 24-hour help line staffed by specialists and other clinicians for people with dementia and their families.

“The need for better access for palliative and hospice care really jumped off the page to me,” Kallymer said of the study’s findings. She was not involved in the research.

“Sometimes in the end stages of life, the family’s agitation and upset and emotional distress … after a long disease can translate to the patient. If someone’s supporting the family then it can be a calmer environment and a better experience.” 

Kallymer said general awareness of dementia is improving, for instance as high-profile people talk about going on with their lives after diagnosis in contrast to its end stages.

In the study, nursing home residents died between June 2010 and March 2015. They were 66 or older. The research was based on an analysis of long-term care databases and couldn’t explore whether the end-of-life interventions and antibiotic use agreed with residents’ expressed wishes. 

Researchers have also found high rates of burdensome interventions among nursing home residents with advanced dementia in the U.S.

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