Assisting Vulnerable Persons During the Holidays

The holiday season is a time of celebration and sharing with family and friends. For some, the holidays may bring an incremental level of burden that may have a negative impact on their heart health. The winter months and holidays can be deadly for people and contribute to an increased risk of heart attacks and cardiovascular death.

Research has demonstrated the winter months (particularly December and January) increase the risk of of AMI and death. Particularly striking is the increase in risk during Christmas/New Year [1,2]. The reasons for this increase in incidence and mortality require further study but may in part be explained by variations in temperature and snow fall.

A six-year retrospective study conducted by local investigators revealed that each 10°C drop in temperature was associated with a 7% increased risk of an ST-Elevation Myocardial Infarction (STEMI). The daily high temperature was a strong predictor of STEMI. Event rates were 0.94/day on days with a temperature less than 0°C, compared to 0.78/day when the daily high was above 0°C. Snowfall did not show an independent effect after adjustment for temperature [3]. This work in Winnipeg demonstrates the effect of the environment on the incidence of STEMI and future research is required to understand interventions that may mitigate this risk.

It is important to note that the increase in heart attack rates is not solely attributed to cold weather. While cold weather can be a risk factor in the Northern Hemisphere, the rise in heart attack cases during the Christmas holidays is observed globally, including in warmer climates. The increase in heart attacks during the holiday season is a complex phenomenon influenced by a combination of lifestyle, behavioral, and environmental factors, applicable in both warm and cold climates.

Stress, depression and worry may be particularly concerning during the holiday season. This may be triggered by caregiving activity, work related factors, increased responsibility during the holidays and socializing commitments [4]. The understanding and the implementation of interventions to assist in the reduction of stress, depression and worry during the holiday season may assist individuals in coping with the myriad of stressors during the holiday season.

Engage in conversations with your patients about the holidays. Acknowledge the holidays may be a difficult and stressful time for some.

Recommendations for Patients:

1. Safe Outdoor Activities: Discuss what activities are safe, especially in extreme weather.

2. Recognizing Heart Attack Symptoms: Emphasize the importance of acting quickly if symptoms arise. They should know to get help right away by calling 911 or their local emergency number.

3. Sharing Responsibilities: Encourage delegation and asking for help.

4. Maintaining Heart Health: Stress the need to continue heart-healthy diets, limit alcohol, and stay physically active.

5. Personal Time: Advise taking breaks to relax and unwind.

6. Planning and Support: Suggest having contingency plans and support networks for stressful periods.

7. Sleep Importance: Highlight the need for adequate sleep.

8. Positive Relationships: Encourage nurturing supportive relationships.

Engaging patients in conversations about the holidays and their unique challenges can be a pivotal step in managing heart health during this period.

References:

[1] Mohammad, MA et al. (2018). Christmas, national holidays, sport events, and time factors as triggers of acute myocardial infarction: SWEDEHEART observational study 1998-2013. BMJ, 363. doi: 10.1136/bmj.k4811: 10.1136/bmj.k4811.

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289164/?report=printable.

[2] Kloner, R.A. et al. (1999). When Throughout the Year Is Coronary Death Most Likely to Occur? A 12-Year Population-Based Analysis of More Than 220 000 Cases. Circulation, 100, 1630-1634. doi: https://doi.org/10.1161/01.CIR.100.15.1630.

Link:https://www.ahajournals.org/doi/10.1161/01.cir.100.15.1630#:~:text=December%20and%20January%20had%20significantly,February%3D2%2C%20etc%5D. Cite as: CMAJ 2017 April 10;189:E546.

[3] Liu, S. et al. (2017). It’s not just the snow; it’s also the cold. CMAJ, April 10, 189. E546.

Link: https://www.researchgate.net/publication/316934664_It%27s_not_just_the_snow_it%27s_also_the_coldust the snow; it's also the cold (researchgate.net)

[4] Olsson, A. et al. (2021). Christmas holiday triggers of myocardial infarction. Scandinavian Cardiovascular Journal, 55(6), 340-344. doi: https://doi.org/10.1080/14017431.2021.1983638.

Tips:

https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=av2118

https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/fend-off-holiday-stress-with-these-tips

https://www.hopkinsmedicine.org/health/wellness-and-prevention/4-mindful-tips-to-destress-this-holiday-season