IMR Press / RCM / Volume 22 / Issue 4 / DOI: 10.31083/j.rcm2204175
Open Access Original Research
Acute cardiovascular events triggered by the COVID-19 pandemic-related stress in non-infected individuals. The Jordan COVID-19 Acute Cardiovascular Events (JoCORE) study
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1 Cardiology Department, Istishari Hospital, 11184 Amman, Jordan
2 Internal Medicine Department, Farah Hospital, 11183 Amman, Jordan
3 Cardiology Department, Abdali Hospital, Abdali Boulevard, 11190 Amman, Jordan
4 Cardiology Section, Internal Medicine Department, King Abdullah University Hospital, 22110 Irbid, Jordan
5 Cardiology Section, Internal Medicine Department, Jordan University Hospital, 11941 Amman, Jordan
6 Cardiology Department, Jordan Hospital, 11196 Amman, Jordan
7 Department of Public Health, Jordan University of Science and Technology School of Medicine, 22110 Irbid, Jordan
8 Al-Raed Heart Center, Cardiology Section, 11194 Amman, Jordan
*Correspondence: a.hammoudeh@istisharihospital.com; hammoudeh_ayman@hayoo.com (Ayman J. Hammoudeh)
Academic Editor: Peter A. McCullough
Rev. Cardiovasc. Med. 2021, 22(4), 1677–1683; https://doi.org/10.31083/j.rcm2204175
Submitted: 22 September 2021 | Revised: 2 November 2021 | Accepted: 8 November 2021 | Published: 22 December 2021
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/).
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
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