Heart attack rates rise with plunging GDP in Greece's financial crisis

The study examined the medical records of 22,093 patients admitted to the cardiology department of the General Hospital of Kalamata over an eight-year span, with patients divided into a pre-financial crisis period from January 2004 through December 2007 or the crisis period, January 2008 through December 2011. The crisis period was defined by change in the country's gross domestic product, or GDP. Patient numbers and demographics were similar in both groups, with 10,870 (49.2 percent) pre-crisis patients and 11,223 (50.8 percent) crisis patients. Because General Hospital has the only cardiology department in Messinia prefecture, one of the country's regional units, these data represent this entire region in southwest Greece.

Researchers found a significant crisis-period spike in heart attacks, with 1,084 heart attacks compared with 841 pre-crisis (22.46 per 10,000 people vs. 17.43 per 10,000). Heart attack incidence rose across the board: 20.8 percent for patients age 45 or younger (64 vs. 53), 25.7 percent for men (807 vs. 642), 29.4 percent for those older than 45 (1,020 vs. 788), and 39.2 percent for women (64 vs. 52).

"Greek women have a higher unemployment rate than men, they are responsible for child care and they also work outside the home -- a formula for stress," said Emmanouil Makaris, MD, a consulting cardiologist at Kalamata's General Hospital.

Factors that might contribute to the higher heart attack rate among older patients include limited job opportunities for unemployed middle-aged men and their much greater prevalence of atherosclerosis, a major risk factor, he said.

"Unemployment is a stressful event and stress is connected with heart disease, but other issues also come with financial difficulties," Dr. Makaris said. "In these times a lot of people do not have money to buy medications or to go to their primary care doctor. There's a great increase in cardiovascular diseases across the country. The cost to the society is very high."

Researchers plan to continue to track heart health and the economy and also hope to expand their work to encompass all of Greece.

"Although Messinia has both urban and agricultural regions, we don't know what is going on in Athens," Dr. Makaris said. "The capital has almost 3 million people and is an urban industrialized area that may be more affected by the financial crisis."

The total GDP loss has been almost 25 percent since the crisis began, and the country remains in financial crisis, with a GDP in 2012 of minus 6 percent and an unemployment rate of 26.8 percent that is still growing.

"We need more support for doctors and patients, more people who can recognize warning signs of myocardial infarction earlier in hospitals," Dr. Makaris said. "In everything surrounding health care -- biomedical supplies, personnel in hospitals -- there are shortages."

With these findings, researchers aim to educate health professionals and policymakers about the serious impact the financial crisis is having on heart health at a time when austerity measures are leading to reductions in medical staff, supplies and services -- and, ultimately, to increase the resources required to cope with escalating need by changing the country's health policy.