Wednesday, March 19, 2014

Tulane University: Post-Katrina Heart Attack Rates - Revisited

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Hurricane Katrina Approaching New Orleans August 2005

 

# 8388

 

In March of 2009, in a study led by Dr. Anand Irimpen (Associate Professor of clinical medicine at Tulane), it was disclosed that residents of New Orleans saw a 300% increase in heart attacks in the first 2 years after hurricane Katrina.

 

The Tulane University news NEW WAVE carried this report in 2009.

Post-Katrina Stress, Heart Problems Linked

March 30, 2009

(Excerpt)

There were 246 admissions for heart attacks, out of a total census of 11,282 patients, post-Katrina compared with 150 admissions out of a total 21,229 patients in the two years before the storm. In addition to a three-fold increase in heart attacks and a 120 percent increase in coronary interventions, the post-Katrina group had significantly higher prevalence of unemployment, lack of medical insurance, medication noncompliance, smoking, substance abuse, first-time hospitalization and people living in temporary housing. There were no significant differences in the racial, gender or age distribution of the two groups.

 

In 2011, we looked at an update to this Tulane study (see Post-Katrina Heart Attack Rates) that found – four years after the disaster – that heart attack rates remained 300% higher than pre-Katrina levels in the City, and that:

 

While psychiatric conditions such as clinical depression, a history of coronary artery disease and marital status did not appear to contribute to heart attacks in the two-year analysis, these factors seem to play a significant role as time has progressed.

Irimpen suggests there is a lag phase between the onset of psychiatric illness and its manifestation in the form of a heart attack. 


Today, Tulane University has announced a 6-year follow up to this study, and once again the impact of Katrina on cardiac health remains pronounced.  First some details on the study, after which I’ll return with more:

 

Rise in Heart Attacks After Hurricane Katrina Persisted Six Years Later

Researchers also find a lasting disruption in the timing of heart attacks after the disaster.

Released: 3/18/2014 10:00 AM EDT
Source Newsroom:
Tulane University

Mayo Clinic Proceedings

Newswise — Lingering stress from major disasters can damage health years later, according to a new Tulane University study that found a three-fold spike in heart attacks continued in New Orleans six years after Hurricane Katrina.

Researchers also found a lasting disruption in the timing of heart attacks in the six years after the storm with significantly more incidents occurring on nights and weekends, which are typically times hospitals see fewer admissions for heart attacks.

The research, which will be published in the journal Mayo Clinic Proceedings, is an update of an ongoing study tracking the increases in admissions for heart attacks at Tulane Medical Center in downtown New Orleans after Hurricane Katrina. The new study confirmed the increase persisted even six years later.

“Prior to Hurricane Katrina, about 0.7 percent of the patients we were treating in our medical center were suffering from myocardial infarctions (heart attacks),” said lead author Dr. Matthew Peters, internal medicine resident at Tulane University School of Medicine. “This increased to about 2 percent in first three years after Katrina and continued to increase to almost 3 percent in years four through six after the storm.”

The hospital had 1,177 heart attack cases during the six years after the storm, representing 2.4 percent of patient admissions; only 0.7 percent of its patients were admitted for heart attacks two years before Katrina.

Researchers attribute the increase to several factors, most notably chronic stress, higher unemployment and greater risk factors for heart disease, such as increased rates of smoking, substance abuse, psychiatric disorders and noncompliance in taking prescribed medications.

“We found more patients without insurance, who were unemployed and more who had a previous history of coronary artery disease, showing us that the milieu of patients was a sicker population,” said senior author Dr. Anand Irimpen, an associate professor of medicine for the Tulane Heart and Vascular Institute and chief, cardiology section, Southeast Louisiana Veterans Health Care System.

Video interviews with both researchers are available online:

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Dr. Matthew Peters – http://youtu.be/2oPOUZZLOmE

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Dr. Anand Irimpen - http://youtu.be/nWANLTsSnzY

 

We’ve looked at other post-disaster health impacts in the past, such as in Post Disaster Stress & Suicide Rates. One disaster discussed was a 1999 7.3 earthquake that struck in Chi-Chi, Nantou county in central Taiwan killing more than 2,300 people.

 

A study that subsequently appeared in the Taiwan Journal of Medicine (Disease-specific Mortality Associated with Earthquake in Taiwan Hsien-Wen Kuo, Shu-Jen Wu, Ming-Chu Chiu) found `a considerable increase in the number of suicides after the earthquake’.

 

A little over a year ago, in Disaster’s Hidden Toll, we looked at the long-term, largely unseen, effect on nursing home patients who were forced to evacuate to temporary facilities after Japan’s Great Earthquake & Tsunami of 2011.

 

A study showed a 2.4 fold increase in deaths during the 8 months following the earthquake.  Deaths not caused by the quake, tsunami, or radiation release itself – but likely brought on by the stress of having to live in make-shift emergency shelters.

 

And just last month, in The Long Term Effects Of A Major Disaster, we looked at the post-tsunami deaths due to stress and displacement that exceeded – at least in one prefecture – those experienced during the initial earthquake and tsunami.

 

Closer to home, last fall in Sandy 1 Year Later: Coping With The Aftermath, we looked at the lingering psychological effects of New England’s brush with that late season super storm of 2012.

 

While the psychological impact of a major disaster cannot be fully prevented, individual, family, and business preparedness can go a long ways towards reducing the impact of any disaster.

 

FEMA, Ready.gov, along with organizations like the American Red Cross (and indeed, this blog), spend a great deal of time trying to convince individuals, families, businesses and communities of the value of preparing for a wide variety of emergencies and disasters.

 

Having a modest supply of food, water, and medicine – and a workable family or business disaster plan – can go a long ways toward reducing both stress and hardship during and after a disaster. The standard advice is that everyone needs to be prepared to deal with a disaster for at least 3 days (meaning having a first aid kit, emergency supplies, and a plan) before help arrives.

 

Sure . . .  they’d like you to be prepared for longer . . .  but 72 hours is a reasonable start. I personally advocate having 2 week’s worth of supplies, but then I live in the heart of hurricane country, and have a fondness for eating regularly (see NPM11: Living The Prepared Life). 

 

Although a good disaster plan and emergency kit are imperative to get you through the opening hours, days, or even weeks of a disaster, knowing how to help friends, family, and neighbors deal with the psychological effects of a disaster can be equally important.

 

While often hidden from view, the psychological impact of a disaster can be enormous and ongoing. Last year in Post Disaster Stress & Suicide Rates we looked at the impact of disaster-related PTSD (Post Traumatic Stress Disorder). Luckily, there are things that can be done - even by the layperson - to help reduce the psychological impact of a disaster. 

 

A few resources you may wish to revisit:

 

In Psychological First Aid: The WHO Guide For Field Workers we looked a simple guidebook anyone can use to help others in emotional distress.

 

The CDC also provides a website which contains a number of resources devoted to coping with disasters.

 

Coping With a Disaster or Traumatic Event

Trauma and Disaster Mental Health Resources

The effects of a disaster, terrorist attack, or other public health emergency can be long-lasting, and the resulting trauma can reverberate even with those not directly affected by the disaster. This page provides general strategies for promoting mental health and resilience. These strategies were developed by various organizations based on experiences in prior disasters.

 

Last August the World Health Organization released a comprehensive Guidelines For Post-Trauma Mental Health Care book on the treatment of PTSD, acute stress, and bereavement:

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The bottom line is that those who follow FEMA’s, and Ready.gov’s advice to Have A Plan, Make A Kit, and Be informed  will be not only be better able to deal with a disaster, they will be better prepared to weather the rigors of a long recovery as well.

 

And that, in turn, could help reduce the risks of post-disaster health issues, such as has plagued New Orleans since Katrina.

 

A few of my (many) blogs on disaster preparedness include:

  • In An Emergency, Who Has Your Back?
  • When 72 Hours Isn’t Enough
  • When Evacuation Is The Better Part Of Valor
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