Abstract 12595: Variation in the Timing of Myocardial Infarctions After Hurricane Katrina: Eight Years After the Storm

Abstract

Introduction: The onset of acute myocardial infarction (AMI) has historically occurred with peaks on weekdays (especially Monday) and mornings, thought to be associated with stressful times of the day and week. AMI incidence increased in New Orleans following Hurricane Katrina with alterations in this chronobiology. The objective of this study is to determine the lasting impact of natural disasters on AMI chronobiology, which is currently unknown. Hypothesis: We hypothesized that the timing of AMI onset would return to pre-Katrina patterns given the amount of time lapsed since the storm. Methods: Single-center, retrospective, observational cohort analysis conducted at Tulane University Health Sciences Center (TUHSC) including symptomatic patients admitted for AMI with elevated troponin I. Exclusions were age < 18 years, hospital transfers, in-hospital AMIs, and inadequate documentation of day and time of symptom onset. There were two cohorts: pre-Katrina, including patients admitted in the 6 years prior to storm landfall (8/29/99 - 8/28/05, n=299), and post-Katrina, including patients admitted in the 8 years after TUHSC re-opened after the storm (2/14/06 - 2/14/14, n=1479). Medical records were reviewed for symptom onset and various demographic, clinical and laboratory data. AMI incidence was defined as the number of AMI admissions divided by total hospital admissions. Results: Post-Katrina AMI incidence decreased on Mondays, weekdays, and mornings, and increased on nights and weekends (p<0.0001, see table). The post-Katrina cohort had a significantly higher prevalence of smoking (53% vs 34%, p<0.01), unemployment (39% vs 7%, p<0.01) and lack of health insurance (25% vs 8%, p<0.01) without significant differences in age or sex. Conclusions: After Hurricane Katrina, the expected morning, weekday, and Monday peaks of AMI onset were eliminated. Traditional patterns of AMI onset may be altered for prolonged periods of time following natural disasters.