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Clinical diagnoses and characteristics of women entering the Reykjavik Emergency Departments during the economic collapse in 2008

Júní 2013

Background: The Prime Minister’s speech to the Icelandic nation on October 6th 2008 dramatically signalled the start of a swift economic collapse in Iceland. An earlier study reported a 40% increase in women attending to the Cardiac Emergency Department (ED) of Landspitali University Hospital in the following week. This spike is now being investigated further to determine underlying clinical characteristics and diagnoses of these women.
Methods: Using electronic medical records at Landspitali, we conducted a retrospective study of all women attending the EDs with an admittance diagnosis of non-cerebrovascular cardiovascular disease and excluding diseases of veins, lymphatic vessels and lymph nodes (ICD 10: I00-I99; I60-69 and I80-89 excluded). The index week started after 4:00pm on October 6th 2008 (week 41) and a comparison period consisted of two weeks before October 6th (weeks 39 and 40). Extensive data was collected including ICD 10 discharge diagnosis, results from blood analysis, ECG results and cardiac catheterization. Information regarding admittance characteristics including risk factors for CVD and length of stay was recorded.
Results: In the week of the economic crisis 25 women were admitted with cardiovascular diagnosis compared to 34 in the preceding two weeks, representing an increase of approximately 47%. Overall, we did not observe differences in admittance characteristics although women attending in the week of the collapse appeared more likely to have arrived with ambulance (p=0.01) and less likely to have reported lipid abnormalities (p=0.05) or a family history of heart disease (p=0.09). Attendees in the collapse week were more likely to be discharged with a diagnosis of ischemic heart disease (ICD 10; I20-I25) (p=0.07). This is, primarily, explained by an increase in cases of angina pectoris (ICD 10 I20) (p=0.03). Blood analysis and ECG results revealed no significant differences when ICD 10 I20-I25 diagnoses were compared. The rate of cardiac catheterization was lower among women in the collapse week (50%) compared to preceding weeks (100%).
Conclusions: Our data confirm increased attendance of women to Reykjavik emergency departments for cardiovascular disease in the week of the economic collapse, particularly due to angina pectoris. These women appeared to some extent to have a more subtle risk profile while small numbers and incompleteness of the data hamper definite conclusion.


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