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Myocardial Infarction and Disasters

By Amesh A. Adalja, MD, FACP, FACEP, April 18, 2014

It is well known that psychosocial stressors place people at risk for adverse health outcomes immediately after a traumatic event. This is especially true for those with underlying coronary artery disease (CAD), the leading cause of death worldwide. However, it has been generally thought that as time passes, the risk returns to baseline. A new study from Tulane University suggests that we may need to rethink that assumption.

Comparison of Patients Pre- and Post-Katrina

Using retrospective methodology, Peters and colleagues compared patients treated for acute myocardial infarction (AMI) at Tulane University Health Sciences Center between August 29, 1999, and August 28, 2005, with patients treated between February 14, 2006, and February 13, 2012.

Their results indicate that the overall percentage of hospital admissions for AMI increased 3-fold, from 0.7% of admissions pre-Katrina to 2.4% post-Katrina. Several other important, and statistically significant, differences in pre- and post-Katrina AMIs were noted. Specifically, post-Katrina patients were found to have higher rates of both CAD and psychiatric illness, and to be younger, more likely to be smokers, more likely to be unemployed, and less likely to be Caucasian.

Chronobiological Changes

One of the most fascinating findings of this study is that the chronobiology of AMI changed post-Katrina. AMIs occur most frequently in the morning and on Mondays and other weekdays. However, post-Katrina, these measures reversed (ie,  AMIs occurred on weekends and outside morning hours).

New Resiliency Measures?

The study suggests a possible additional means to gauge the resiliency of a city after a catastrophic natural disaster occurs. Traditionally, factors such as infrastructure repair, housing, and commerce are considered measures of recovery. However, this study illustrates that 6 years after such an event—after which a city’s population is deemed to have recovered by conventional standards—a residual deficit in the health outcomes remains.

Addressing such multifactorial conditions as CAD and AMI is challenging, and multiple disciplines may have to be enlisted to reduce the prevalence of known risk factors for AMI. Coupled with prior studies that have shown similar shorter-term associations with adverse health outcomes and natural disasters, this study is an important addition to the disaster literature and should further inform recovery efforts and the measurements of resiliency in future disasters.

Reference: Peters MN, Moscona JC, Katz MJ, et al. Natural disasters and myocardial infarction: the six years after Hurricane Katrina. Mayo Clin Proc 2014;89:472-477.