Heart attack deaths spike over the holidays

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Death rates from heart disease, as well as deaths from all other causes, are more common around Christmas and New Year’s Day than other days of the year, U.S. researchers report.

The exact reason for the increased number of deaths during the holiday season is unknown, but study author Dr. David P. Phillips of the University of California at San Diego and his colleagues speculate it may be partly related to patients’ reluctance to seek medical care during the holidays.

"Don’t postpone getting medical care just because it’s a holiday,” Phillips told AMN Health. He added that those who travel during the holiday season should investigate the medical resources available at their destination before leaving home.

Previous studies have shown that suicides, homicides and automobile-related deaths increase during the winter holiday season. Also, a 1999 study found that heart-related deaths in Los Angeles County were more common during the winter months of December and January.

Phillips and his team conducted a study to determine whether the increased number of winter deaths is related to the holiday season. To this end, they examined death certificates of 53 million Americans who died from 1973 to 2001.

Overall, there were “distinct spikes” in both heart- and nonheart-related deaths around Christmas and New Year’s, Phillips and his team report in Circulation: Journal of the American Heart Association. This spike in holiday deaths accounted for 42,039 more deaths than would have normally been expected.

What’s more, the number of deaths occurring around the holidays “gradually increased” during the 26-year study period, the researchers note. This “public health problem is not fixing itself,” Phillips noted.

When Phillips and his team examined heart-related deaths that occurred among patients who died as outpatients or who died in the emergency department, they found that 4.65 percent and 4.99 percent more heart-related and nonheart-related deaths, respectively, occurred than would have been expected. Further, most of these patients died on December 25, 26 or January 1.

Deaths from causes unrelated to heart conditions were also more common on these three days, which Phillips described as “the most popular days of the year to die.”

The reason for the holiday-related spike in deaths could not be explained by factors such as respiratory diseases, holiday-associated emotional stress or changes in diet or alcohol drinking, study findings indicate.

The increase in deaths over the holidays may be partly due to patients’ tendencies to delay seeking medical care until after the holiday season, the researchers speculate. However, this would not explain the spike in deaths observed among nursing home patients.

Another possible explanation is staffing changes that typically occur during the holiday season, including scheduling changes for doctors, nurses, pharmacists and even health insurance personnel, Phillips said. Vigorous research is needed to determine if such changes “reduce the quality of medical care,” he said.

In a related editorial, Dr. Robert Kloner, of the Good Samaritan Hospital in Los Angeles, who authored the 1999 study, agrees that more research is needed to determine the mechanism for the “Merry Christmas coronary” and the “Happy New Year heart attack.”

“Our study and the fine study of Phillips et al. clearly suggest that the winter season is associated with a significant increase in cardiac deaths,” he writes, adding that doctors should be aware of this phenomenon, particularly the spike in deaths during the holidays, and “help their patients to minimize coronary risk factors and factors that will trigger” heart attack.

SOURCE: Circulation: Journal of the American Heart Association, December 14, 2004.

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