FREEDOM Trial Finds That High-Dose Anticoagulation Can Improve Survival for Hospitalized COVID-19 Patients

Mar 7, 2023 | Cardiology, COVID-19, Featured, Research

The FREEDOM trial was initiated and led by Valentin Fuster, MD, PhD, President of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital.

An international trial led by Mount Sinai found that high-dose anticoagulation can reduce deaths by 30 percent and intubations by 25 percent in hospitalized COVID-19 patients who are not critically ill, when compared to the standard treatment, which is low-dose anticoagulation. The innovative FREEDOM trial was initiated and led by Valentin Fuster, MD, PhD, President of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital.

The study results were announced Monday, March 6, in a late-breaking clinical trial presentation at the scientific sessions of the American College of Cardiology Together With World Congress of Cardiology (ACC.23/WCC) in New Orleans and simultaneously published in the Journal of the American College of Cardiology.

“What we learned from this trial is that many patients hospitalized with COVID-19 with pulmonary involvement, but not yet in the intensive care unit (ICU), will benefit from high-dose subcutaneous enoxaparin or oral apixaban to inhibit thrombosis and the progression of the disease,” Dr. Fuster says. “This is the first study to show that high-dose anticoagulation may improve survival in this patient population—a major finding since COVID-19 deaths are still prevalent.”

Clinical Insights, Early in the Pandemic

This work was prompted by the discovery early in the pandemic that many patients hospitalized with COVID-19 developed high levels of life-threatening blood clots. In March 2020, during the early days of the pandemic, Dr. Fuster observed patients with blood clots in their legs who had been admitted with COVID-19. After hearing from colleagues abroad of other cases of small, pervasive, and unusual clotting that had triggered myocardial infarctions, strokes, and pulmonary embolisms, he initiated decisive action.

“We became one of the first medical centers in the world to treat all COVID-19 patients with anticoagulant medications,” says Dr. Fuster, a pioneer in the study of atherothrombotic disease. “It was a decision that we believe saved many lives.”

This early protocol led to groundbreaking research and insights by Mount Sinai into the role of anticoagulation in the management of COVID-19-infected patients. Mount Sinai research showed that treatment with prophylactic (low-dose) anticoagulation was associated with improved outcomes both in and out of the intensive care unit among hospitalized COVID-19 patients. Researchers further observed that therapeutic (high-dose) anticoagulation might lead to better results. Then, they designed the FREEDOM COVID Anticoagulation Strategy Randomized Trial to look further into the most effective regimen and dosage for improving outcomes of hospitalized COVID-19 patients who are not critically ill.

Researchers enrolled 3,398 hospitalized adult patients with confirmed COVID-19 (median age 53) from 76 urban and rural hospitals across 10 countries—including hospitals within the Mount Sinai Health System—between August 26, 2020, and September 19, 2022. Patients were not in the ICU or intubated, and about half of them had signs of COVID-19 impacting their lungs with acute respiratory distress syndrome (ARDS). Patients were randomized to receive doses of three different types of anticoagulants within 24 to 48 hours of being admitted to the hospital and followed for 30 days. Equal numbers of patients were treated with one of three different drug regimens: low-dose injections of enoxaparin, high-dose injections of enoxaparin, and high-dose, oral doses of apixaban. They compared the combined therapeutic groups to the prophylactic group.

Informing Future Care

The primary endpoint was a combination of death, requirement for ICU care, systemic thromboembolism (blood clots traveling through the arteries), or ischemic stroke at 30 days. This endpoint was not significantly reduced among the groups. However, 30-day mortality was lower for those treated with high-dose anticoagulation compared with those on the low-dose regimen. Seven percent of patients treated with the low-dose anticoagulation died within 30 days, compared with 4.9 percent of patients treated with high-dose anticoagulation—an overall reduction of 30 percent. The need for intubations was also reduced in the high-dose group: 6.4 percent of patients on the high-dose regimen were intubated within 30 days compared with 8.4 percent in the low-dose group—a 25 percent reduction. The study showed high-dose anticoagulation to be especially beneficial for patients with ARDS, a condition where COVID-19 damages the lungs. Among patients with ARDS at the time of hospital admission, 12.3 percent in the low-dose anticoagulation group died within 30 days, compared with 7.9 in the high-dose group.

All groups had low bleeding rates, and there were no differences between the two therapeutic blood thinners for safety and efficacy.

“This is an important study for patients with COVID-19 who are sick enough to require hospitalization but not so ill as to require ICU management. In this group of patients with radiologic evidence of ARDS, therapeutic dose anticoagulation prevents disease progression, especially the need for intubation, and saves lives,” says co-Principal Investigator Gregg W. Stone, MD, Professor of Medicine (Cardiology), and Population Health Science and Policy, at the Icahn School of Medicine at Mount Sinai. “This is especially important as COVID-19 is not going away. Even in the United States, the current number of daily deaths, although much lower than at the peak of the pandemic, is twice that compared with just one year ago. And in other countries COVID-19 is raging”

The FREEDOM trial was coordinated by the Mount Sinai Heart Health System. Dr. Fuster raised all funding for the trial.

Mount Sinai Cardio-Oncology Program Receives Highest Designation for Excellence

Updated on Aug 4, 2022 | Cancer, Cardiology, Featured, Heart Health

Gagan Sahni, MD, Director of Mount Sinai’s Cardio-Oncology Program, center, with team members Chime Lhamu, NP, left, and Lashawanda Rosser, patient services coordinator.

The Cardio-Oncology Program at The Mount Sinai Hospital, under the directorship of Gagan Sahni, MD, has been awarded Gold Center of Excellence status. This is the highest designation of certification from the International Cardio-Oncology Society (IC-OS), the largest international platform for physicians and nurse practitioners dedicated to cardiovascular care of cancer patients.

Mount Sinai is the first institution in New York State to be awarded Gold status as a Cardio-Oncology Center of Excellence by IC-OS. Only 22 cardio-oncology programs nationwide and 31 worldwide have been awarded this recognition acknowledging exceptional cardiovascular care of oncology patients. This international honor by IC-OS is awarded at three levels—bronze, silver, and gold. To receive a Gold certification, the institution must fulfill stringent requirements across six scoring categories, including patient volume, research and publications, interdisciplinary care, education, committee involvement, and program building. It is valid for three years and signifies the program has demonstrated outstanding professional contributions to Cardio-Oncology.

“Many cancer treatments—which includes chemotherapy, radiation, and immunotherapy—can adversely affect the heart, and it is imperative that the appropriate patients are referred to a specialist in the field of Cardio-Oncology in a timely way,” explains Dr. Sahni, Associate Professor of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai.

“My specialty focuses on early prevention, detection, treatment, and management of the potential cardiac effects of cancer treatments, so that the patients are able to safely continue their therapies. These cardiac adverse effects may include a myriad of conditions such as congestive heart failure, hypertension, arrhythmias, blood clots, angina, and pericardial effusion—a buildup of fluid around the heart. All of these conditions should be addressed promptly by a specialist who is familiar with the effects of cancer therapies and coordinates tailor-made cardiology care with the patient’s oncologist.”

The Cardio-Oncology clinic at Mount Sinai was established in 2013 by Dr. Sahni, who is a Fellow of the International Cardio-Oncology Society, one of fewer than 20 physicians in the world awarded this distinction for her contributions to the field. The program provides personalized cardio-oncology consultations to more than 2,500 cancer patients annually from The Tisch Cancer Center and across the Mount Sinai network with inpatient, outpatient, and telemedicine consultations. This includes nearly a decade of close multidisciplinary collaborations with oncologists, radiation oncologists, onco-surgeons, onco-generalists, onco-nephrologists, onco-neurologists, onco-endocrinologists, and nurse practitioners.

“This designation of Gold Center of Excellence recognizes the dedication of the Cardio-Oncology team at The Mount Sinai Hospital in advancing specialized heart care for our cancer patients at a nation-leading level, and we are proud to be able to provide state-of-the-art specialty care to them,” says Dr. Sahni.

Physicians can make Cardio-Oncology appointments for their patients by emailing Dr. Sahni at gagan.sahni@mountsinai.org or calling 212-241-4977.

Learn more about the Cardio-Oncology Program at The Mount Sinai Hospital

The Mount Sinai Hospital Receives Highest Honors for Cardiac Surgery

Updated on Jul 19, 2022 | Cardiology, Featured

From left: Ismail El-Hamamsy, MD, PhD, Director of Aortic Surgery, Mount Sinai Health System; Ahmed El-Eshmawi, MD, Clinical Director of the Mitral Valve Repair Center at The Mount Sinai Hospital; Percy Boateng, MD, National Director of the Mitral Valve Repair Center at The Mount Sinai Hospital; David H. Adams, MD, Cardiac Surgeon-in-Chief and Chair of Cardiovascular Surgery, Mount Sinai Health System; Anelechi Anyanwu, MD, Surgical Director of Heart Transplantation and Mechanical Circulatory Support, Mount Sinai Health System; Robin Varghese, MD, MS, FRCSC, Director of Cardiovascular Critical Care, Mount Sinai Health System; Zdravka Zafirova, MD, Director of the Cardiovascular Intensive Care Unit, The Mount Sinai Hospital; and Menachem Weiner, MD, Director of Cardiothoracic Anesthesia, The Mount Sinai Hospital.

The Mount Sinai Hospital is world renowned for its expertise in cardiac valve surgery. That legacy continues as it received recent top ratings for patient safety and superior outcomes from the New York State Department of Health and the Society of Thoracic Surgeons, in addition to the 2022 Mitral Valve Repair Reference Center Award from the American Heart Association and the Mitral Foundation.

In  one of the significant outcomes reports, Adult Cardiac Surgery 2016-2018, the New York State Department of Health found that The Mount Sinai Hospital performed better than the state safety average for isolated valve surgeries and combined valve and CABG procedures, while performing more of these procedures—3,108—than any other hospital in the state.

The report also awarded its highest quality rating for cardiac valve surgery to David H. Adams, MD, Cardiac Surgeon-in-Chief, Mount Sinai Health System, and the Marie-Josée and Henry R. Kravis Professor and Chair of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai.

During the study period, Dr. Adams’s safety results were significantly better than the state average for isolated valve surgery and combined valve and coronary artery bypass graft (a risk adjusted mortality rate of 0.18 compared to the State average of 2.10), while performing 1,001 of the procedures—more than any other surgeon in New York State.

“It is a real honor to be recognized by the state for our commitment to quality at Mount Sinai,” Dr. Adams said. “Our ability to achieve positive outcomes for our patients and maintain a high degree of safety with a high volume of cases exemplifies the considerable skills, discipline, and dedication of our entire multidisciplinary team—including our anesthesiologists, intensivists, residents, nursing and perfusion staff, clinical coordinators, and the incredible group of cardiologists and sub-specialists that help take care of our patients. I am proud of all of them and of the exacting standards we have set for the care of our patients at Mount Sinai.”

“The health and safety of our patients is our priority, now and always,” said Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital. “All of us at Mount Sinai are very proud to be recognized for our commitment to quality care and our outcomes in cardiac surgery, and we continue to draw inspiration from that to do even better.”

Recognized by Society of Thoracic Surgeons

The team’s standards have also earned honors from the Society of Thoracic Surgeons (STS), which recognized The Mount Sinai Hospital with its distinguished three-star rating based on Mount Sinai’s commitment to patient care and the outcomes it achieved in three categories: mitral valve repair and replacement (MVRR), coronary bypass surgery (CABG), and aortic valve replacement and CABG (AVR-CABG).

The STS star rating system is one of the most sophisticated and highly regarded overall measures of quality in health care, and Mount Sinai’s performance places it among the elite in all three categories in the United States and Canada. Historically, 20 percent of participating centers have received the three-star rating for CABG, and 4 to 7 percent have received it for AVR and CABG.

“This star rating system is the premier clinical way of rating hospitals based on their performance and it is exciting that STS has named Mount Sinai the best of the best in three categories,” said Julie Swain, MD, Vice Chair and Professor of Cardiovascular Surgery at Icahn Mount Sinai. “There are very few centers that achieve a three-star rating in multiple specialties, which reinforces the fact that we are among the top hospitals in the world when it comes to performing safe, successful mitral valve, coronary bypass, and other cardiac operations.”

Mitral Valve Repair Reference Center Award

The program was also honored to receive the American Heart Association – Mitral Valve Repair Reference Center Award, which recognizes medical centers that have a demonstrated record of superior clinical outcomes and a commitment to reporting and measuring mitral valve repair-related metrics. It also promotes the centers that have received this award to improve access to quality care among patients nationwide.

“This prestigious award is a testament not just to the excellence of our surgeons but also to our comprehensive team approach to all aspects of patient care from first consultation to post-operative follow-ups,” Dr. Swain said. “We have been refining that approach, and the system that supports it, for years through ongoing quality assessments and we are seeing the results of that effort in the honors we receive and, more important, the results we achieve for our patients.”

 

Non-Hispanic Blacks Found Twice as Likely to Have Atherosclerosis as Hispanics in Study of Young Adults in Harlem

Updated on Jul 15, 2022 | Cardiology, Diversity and Inclusion, Featured, Research

A unique Mount Sinai study focused on a multiethnic, underserved community in Harlem found that young non-Hispanic Black adult participants were twice as likely to have atherosclerosis as young Hispanic adults.

The research, published in the Journal of the American College of Cardiology in July 2022, is part of the FAMILIA Project at Mount Sinai Heart, a pioneering trial created by Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital.

The new study is one of the first to evaluate atherosclerosis—the plaque build-up in the arteries that can lead to a heart attack or stroke—in asymptomatic young populations. Its findings emphasize the importance of early screening and lifestyle interventions in high-risk minority groups to improve their cardiovascular (CV) health.

Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital.

“What’s interesting about this study is that Black individuals appear to be more vulnerable to atherosclerosis early in life than people of Hispanic origin, even when adjusting for known cardiovascular and lifestyle risk factors such as smoking, unhealthy diet, lack of exercise, high blood pressure, and cholesterol,” Dr. Fuster says. “This can then put them at increased risk of cardiovascular disease, suggesting the existence of emerging or undiscovered cardiovascular risk factors in this population.”

The study is part of a multinational effort to intervene early in the lives of children, their caretakers, and teachers so they can form a lifetime of heart-healthy habits. These new results come after highly successful interventions involving more than 500 preschoolers, caretakers, and educators at 15 Head Start schools in the Harlem section of Manhattan, an urban area that is socioeconomically disadvantaged—a situation commonly linked to higher rates of obesity, heart disease, and other health issues.

The FAMILIA team focused on 436 adults, including preschoolers’ family members, caretakers, teachers, and school staff. Of that group, 147 participants were non-Hispanic Black and 289 were Hispanic, with an average age of 38; 80 percent were women. Non-Hispanic white, Asian, and Native American groups each formed a small proportion of participants (2.3 percent, 2.3 percent, and 0.3 percent respectively) and people in those groups were excluded from the analysis.

Each participant answered a comprehensive questionnaire at the start of the study, addressing their nutrition, physical activity, tobacco use, and alcohol consumption, and whether they had conditions such as heart disease, hypertension, diabetes, or a family history of health problems. They also had their weight recorded, and blood pressure and cholesterol checked.

Overall cardiovascular risk factors were prevalent for both ethnic groups at baseline. Thirty percent of non-Hispanic Black participants had hypertension, almost triple the rate of the Hispanic group, 11 percent. Conversely, non-Hispanic Black participants had lower rates of dyslipidemia—unhealthy levels of lipids/fat in the blood (18 percent) compared to the Hispanic group at 27 percent, and better eating habits, consuming more fruits and vegetables. Researchers used these data to calculate a predicted cardiovascular risk score for each group. They found the overall risk of having a cardiovascular event in 10 years was low for both Blacks and Hispanics—around four percent for both groups.

Participants also had 3D vascular ultrasounds to determine if they had atherosclerosis in their carotid (neck) and femoral (leg) arteries. These vascular ultrasounds pointed to a significant discrepancy between the groups. Overall, nine percent of participants had subclinical atherosclerosis (nearly one in ten participants showed at least one artery with plaque). Also, the rate of plaque build-up in the arteries was two times higher among non-Hispanic Blacks than Hispanics. The results were consistent even after adjusting for classic cardiovascular risk factors including age, sex, body mass index, hypertension, diabetes, and cholesterol; lifestyle factors including diet, physical activity, and tobacco use; and socioeconomic factors such as employment status.

The study noted some limitations and areas for further investigation. “The population included in the study was from a specific area, Harlem, with known intrinsic health disparities compared with other areas in New York City,” the study said. “This could, to some extent, limit our results’ generalizability.” In addition, “Given the heterogeneity among racial and ethnic groups, assessing associations between self-reported racial or ethnic identity and disease is complex and is vulnerable to confounding due to the effects of socioeconomic inequality, environmental disparity, unequal access to care, and other possible emerging or unknown CV risk factors.”

However, the study is one of the first to assess the presence of subclinical atherosclerosis by 3D vascular ultrasounds in an underrepresented younger population, the research team says, and it contributes to the understanding of higher rates of CV disease observed at an early age in disadvantaged communities.

“These findings may in part help to explain the observed differences in cardiovascular disease prevalence between racial and ethnic groups,” Dr. Fuster says. “Until underlying biological factors and other undiscovered cardiovascular risk factors are better understood and can be addressed by precision medicine, affordable noninvasive imaging techniques such as the portable 3D vascular ultrasounds used in this study, which are easily used and affordable, can be an important form of early detection in underserved communities, and provide valuable information about population disparities and increase the precision of health promotion and prevention programs.”

Dr. Fuster and his team will expand the FAMILIA program to schools across the five boroughs of New York City starting in September 2022. This project will also evaluate how family socioeconomic status and teachers’ characteristics may affect the implementation and efficacy of school-based health promotion programs.

The FAMILIA project was funded by a grant from the American Heart Association.

 

Learn more about Mount Sinai Heart

Prestigious Award Named in Honor of Valentin Fuster, MD, PhD, by American College of Cardiology

Updated on Jun 30, 2022 | Cardiology, Featured

The American College of Cardiology (ACC) has established a new award in honor of Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital.

The first “Valentin Fuster Award for Innovation in Science” was announced at ACC’s 71st Annual Scientific Session in Washington on Monday, April 4. It was presented to Dr. Fuster to honor his significant contributions to cardiovascular medicine as a champion of scientific research and an innovator in the delivery of science through novel mechanisms, and his international voice on the importance of embracing scientific inquiry to improve the care of cardiovascular patients and promote life-long heart health.

The award will be given to a single physician annually for the next 15 years.

Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital, right, with Dipti Itchhaporia, MD, FACC, President of the American College of Cardiology.

“I am grateful to have this award established in my honor. I am proud to begin this legacy and hope this motivates others to have a significant impact in the field of cardiovascular medicine,” Dr. Fuster said. “I look forward to meeting future honorees and learning about their contributions to combating heart disease and promoting health.”

Dr. Fuster is currently the Editor in Chief of the Journal of the American College of Cardiology (JACC), which ranks among the top cardiovascular journals in the world for its scientific impact. He is a past president of both the American Heart Association and the World Heart Federation. He is a member of the National Academy of Medicine, where he served as chair of the Committee on Preventing the Global Epidemic of Cardiovascular Disease, and was a Council member of the National Heart, Lung and Blood Institute. Dr. Fuster was also President of the Training Program of the American College of Cardiology.

Dr. Fuster’s research is unparalleled in areas relating to the causes, prevention, and treatment of cardiovascular disease globally, and spans the full range from hardcore basic science and molecular biology through clinical studies and large-scale multinational trials to population health and global medicine. He has 35 worldwide honorary degrees and is the most highly cited Spanish research scientist of all time, according to Google Scholar.

In addition to Dr. Fuster, four other top cardiovascular physicians from Mount Sinai Heart received prestigious honors at the ACC Scientific Session.

George Dangas, MD, PhD, Professor of Medicine (Cardiology) and Director of Cardiovascular Innovation at the Zena and Michael A. Wiener Cardiovascular Institute at the Icahn School of Medicine at Mount Sinai, was awarded the 2022 Master of the ACC Award by the American College of Cardiology. This recognizes and honors his consistent contributions to the goals and programs of the ACC and his leadership in important College activities. Recipients of this award must be members of the College for at least 15 years and have served with distinction and provided leadership on various College programs and committees.

Robert Rosenson, MD, Professor of Medicine (Cardiology) and Director of Cardiometabolic Disorders at Icahn Mount Sinai, and Gilbert Tang, MD, MSc, MBA, Professor of Cardiovascular Surgery at Icahn Mount Sinai, received the 2022 Simon Dack Award for Outstanding Scholarship for their exceptional contributions to JACC for their peer reviews. Dr. Rosenson and Dr. Tang are among five physicians to earn this distinguished honor for 2022. Criteria include reviewing more than 11 papers a year and being on time with their reviews 100 percent of the time. This is the sixth time Dr. Rosenson will receive this award, and the second time for Dr. Tang.

William Whang, MD, Associate Professor of Medicine (Cardiology) at Icahn Mount Sinai, has been named an Elite Reviewer for the Simon Dack Award for Outstanding Scholarship for contributing high-quality critiques to the journal. Criteria include reviewing more than nine papers a year and reviewing on time 85 percent of the time. Dr. Whang is among 10 physicians to receive this honor for 2022.  This will be Dr. Whang’s second time receiving the Elite Reviewer award.  He is also a two-time past recipient of the Simon Dack award.

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First-Time Mother Receives Life-Saving Aortic Surgery

Updated on Jun 30, 2022 | Cardiology, Featured, Patient Stories

From left, Ismail El-Hamamsy, MD, PhD, Yulia Nurikyan, and Percy Boateng, MD.

A first-time mother received life-saving heart surgery at The Mount Sinai Hospital, thanks to her quick response to her symptoms and knowledge of her family’s health history, says a leader of her surgical team, Ismail El-Hamamsy, MD, PhD, Director of Aortic Surgery, Mount Sinai Health System, and first author of a recent paper on aortic dissection repair during the COVID-19 pandemic.

The patient, Yulia Nurikyan, was 38 weeks pregnant and had not been feeling well, with a backache that she thought was caused by her late-stage pregnancy. In mid-May, in the heat of the COVID-19 pandemic, she woke up at 5 am with a heavy feeling in her throat. She got out of bed for a glass of water, then fainted. Her husband, Antoan, quickly called 911, and an ambulance rushed her to Elmhurst Hospital in Queens.

Ms. Nurikyan told the medical team at Elmhurst that her father had died of an aortic dissection in his 40s, so they ordered a CT scan and other diagnostic tests, which showed that she had a bicuspid aortic valve. This was crucial information. About half of patients with this heart defect develop an aortic aneurysm, an enlargement of the vessel that can lead to aortic dissection. This is a tear in the inner layer of the aorta, the main blood vessel that brings oxygenated blood to the rest of the body. Some people with an aortic dissection feel no pain, but common symptoms are severe sudden pain in the upper back or chest, shortness of breath, and dizziness or fainting.

Ms. Nurikyan underwent an emergency C-section, delivering a baby girl, Livia. She held her daughter for a few minutes, then she was rushed to The Mount Sinai Hospital for emergency heart surgery, since the imaging tests suggested that her aorta was about to rupture, which could have proved fatal.

Yulia and Antoan Nurikyan with baby Livia.

“In cardiac surgery, this situation is at the top of the list of emergencies,” says Dr. El-Hamamsy, who treated Ms. Nurikyan as soon as she arrived. Dr. El-Hamamsy, senior faculty in Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai, is an expert in the repair of aortic dissection and recently published a study that found a significant decline in reported cases during the COVID-19 crisis.

In the study, published in May in the Journal of the American College of Cardiology, researchers compiled data on surgical repair of acute Type A aortic dissection in 11 New York City hospitals from January 1, 2018, to April 15, 2020, counting March 1, 2020, as the first day of the COVID-19 pandemic in the city. The study found that these surgical repairs fell 76 percent after the COVID-19 pandemic began—from 12.8 cases per month before the pandemic to 3 cases per month after the pandemic.

The investigators presented several potential reasons for the decline, suggesting, for example, that some aortic dissection patients did not call for help, fearing COVID-19 infection; or busy first responders were delayed in providing aid; or overburdened emergency departments may have missed or delayed diagnoses. The study said, “Although no causal relationship can be firmly established among the drop in type A aortic dissections, the COVID-19 outbreak in New York City, and the increase in at-home deaths since the last week of March 2020, this gives pause for thought.”

Ms. Nurikyan experienced a Type A aortic dissection. In a successful procedure, Dr. El Hamamsy repaired her bicuspid aortic valve, removing some of the injured blood vessel and replacing it with a synthetic graft, working with David H. Adams, MD, the Marie-Josée and Henry R. Kravis Professor and Chair of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai, and the Cardiac Surgeon-in-Chief of the Mount Sinai Health System, and Percy Boateng, MD, Assistant Professor of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai.

Ms. Nurikyan’s baby, Livia, had remained at Elmhurst, placed in neonatal intensive care because of fluid in her lungs. Ms. Nurikyan and daughter spent a week at separate hospitals, and her husband could not visit either of them due to safety rules during the pandemic, though the hospitals kept them in touch through video calls. The family was happily reunited on May 23, when Ms. Nurikyan was picked up by her husband and they went together to get Livia. “My baby was the one who got me through it,” she said in an article on her care in the Daily News. She said she was grateful for her healthier heart and for the compassionate and expert care her new family received.

Ms. Nurikyan’s quick response to her symptoms was crucial, Dr. El-Hamamsy says, a point reinforced by the recent study. “It is critical, as we adjust to the pandemic, to balance the public health imperative of social distancing with the individual need to consult in the presence of sudden severe symptoms. Furthermore, additional resources, ranging from telemedicine to numbers of first responders, should be greatly increased,” the study concluded. “This serves as a word of caution for cities yet to experience a surge in COVID-19 cases, as well as for future similar events.”

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