January 14, 2025 – Emergency hospital visits declined substantially for acute coronary syndrome, across several demographic groups, during the COVID-19 pandemic, according to a study conducted by Hebrew University of Jerusalem researchers.

The study, published in the International Journal of Epidemiology, revealed older adults, particularly women, disproportionately avoided critical cardiac care more frequently during periods of high virus transmission. The research provides valuable insights into how public health emergencies can alter healthcare-seeking behavior and underscores the urgent need to build trust and ensure access to life-saving care for vulnerable populations in future emergencies.

The study analyzed data from 61,349 emergency visits for acute coronary syndrome across Israel between January 2018 and December 2021. By examining trends during three distinct periods—the pre-pandemic phase (January 2018 to February 2020), the early-pandemic phase (March 2020 to January 2021), and the late-pandemic phase (February 2021 to December 2021)—the researchers observed a notable reduction in visits during times of high COVID-19 morbidity and mortality.

During the early-pandemic phase, which included lockdowns, the largest decrease was seen among women aged 65 and older, with visits falling by 18.4 percent compared to pre-pandemic trends. Men aged 25 to 64 experienced the smallest decline, with a reduction of 7.2 percent. In the late-pandemic phase, which was characterized by high vaccination rates and no lockdowns, visits by women aged 25 to 64 still showed a decline of 20.1 percent.

“These findings underscore the profound effect health crises like the COVID-19 pandemic can have on access to critical care,” said Prof. Levine of the Hebrew University Braun School of Public Health and Community Medicine, who supervised Alexander Kagan, working on his masters of public health degree. “It shows the urgent need for public health strategies that ensure healthcare remains accessible and trusted during future emergencies.”

Moreover, the study’s data-driven approach highlights the need for real-time monitoring systems and predictive modeling to anticipate healthcare trends during crises. Targeted public health messaging at different phases of emergencies is crucial to ensure safety, reduce hesitancies, and encourage follow-up care. The broader implications point to the necessity of designing adaptable, crisis-resilient systems that address systemic inequities and reduce preventable harm during future health emergencies and other catastrophes. These insights emphasize the importance of proactive, inclusive strategies in ensuring equitable access to life-saving care.

The research paper titled “Acute coronary syndrome rates by age and sex before and during the COVID-19 pandemic in Israel: nationwide study” is now available in the International Journal of Epidemiology and can be accessed here.

Researchers:

Alexander Kagan1, Donna R Zwas2, Ziona Haklai3, Hagai Levine1

Institutions:

1) The Braun School of Public Health and Community Medicine, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem

2) Division of Cardiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem

3) Ministry of Health, Health Information Division