Cardiac Events in New Jersey After the September 11, 2001, Terrorist Attack

Abstract

The higher stress associated with the World Trade Center (WTC) attacks on September 11, 2001, may have resulted in more cardiac events particularly in those living in close proximity. Our goal was to determine if there was an increase in cardiac events in a subset of emergency departments (EDs) within a 50-mi radius of the WTC. We performed a retrospective analysis of consecutive patients seen by ED physicians in 16 EDs for the 60 days before and after September 11 in 2000-2002. We determined the number of patients admitted to an inpatient bed with a primary or secondary diagnosis of acute myocardial infarction (MI) or tachyarrhythmia. In each year, we compared patient visits for the 60 days before and after September 11 using the chi-square statistic. For the 360 days during the 3 years, there were 571,079 patient visits in the database of which 110,766 (19.4%) were admitted. Comparing the 60 days before and after September 11, 2001, we found a statistically significant increase in patients with MIs (79 patients before versus 118 patients after, P =.01), representing an increase of 49%. There were no statistically significant differences for MIs in 2000 and 2002 and in tachyarrhythmias for all three years. For the 60-day period after September 11, 2001, we found a statistically significant increase in the number of patients presenting with acute MI but no increase in patients admitted with tachyarrhythmias.

Immediate surge in female visits to the cardiac emergency department following the economic collapse in Iceland: an observational study

“…The role of acute mental stress as a trigger of cardiovascular events is, however, well established. Our findings are indeed in line with findings from a number of studies indicating an immediate increase in cardiovascular morbidity or mortality following stressful events, such as natural disasters,3 4 war or terrorism,5 6 the diagnosis of a life-threatening disease,7 8 loss of a child9 and major sporting events 10. Furthermore, Stuckler and coworkers11 reported a 6.4% increase in male cardiovascular mortality during the first year following banking crises in 19 high-income countries; the study did not address female cardiovascular morbidity.…”

Mental Health Consequences of September 11: A Five-Year Review of the Behavioral Sciences Literature

“…It was determined that there was a significant 49% increase in the cases admitted to hospitals. This study indicates that the high stress levels experienced as a result of the disaster may have contributed to an elevation in the level of heart attack cases in New Jersey (Allegra et al 2005).…”

Burden of Cardiovascular Morbidity and Mortality Following Humanitarian Emergencies: A Systematic Literature Review

“…12 Two studies examined outcomes to 60-days; a study of 16 hospitals in New Jersey found a 49% increase (p=0.01) in the incidence of AMI in the 60 days following the event (42% when the number of patients presenting to the ED was controlled for). 14 A study of admissions to the telemetry and coronary care units at a single center in Brooklyn also identified an increase in the overall occurrence of cardiac events in the post-exposure period compared to the corresponding period in 2010 (p=0.008). 13 Interestingly, the incidence of AMI and tachyarrhythmia was increased following the event, however, the incidence of admission for unstable angina did not change.…”

“…10, 12, 13, 18, 19, 21, 23, 26, 28 This is particularly apparent when considering studies of the September 11 th terrorist attacks since many patients did not report to work in Manhattan in the weeks after the event, altering the daily hospitalization patterns of patients both in the city and in the surrounding areas. 12–14 As almost all studies utilized historical controls from the previous year, the comparison population was generally similar to the exposed population. Comparability of the groups was not always well reported, and was particularly concerning for the three studies describing the effects of long-term conflict on the population.…”