The 2015 and 2016 terrorist attacks in France: was there a short-term impact on hospitalizations for cardiovascular disease?

Abstract

Background: The terrorist attacks in Paris and Nice in 2015 and 2016 generated widespread emotional stress in France. Given that acute emotional stress is a well-known trigger for cardiovascular disease, we investigated whether these attacks had any short-term impact on hospitalizations for acute cardiovascular disease in France.

Methods: Annual hospital discharge data from 2009 to 2016 were extracted from the French Hospital Discharge Database. All hospitalizations with a primary diagnosis of acute coronary syndrome, heart failure, or stroke were selected. Generalized additive Poisson models were used to differentiate "unusual" variations in daily hospitalization numbers in the 15 days following the attacks from the expected background hospitalization rate.

Results: The average daily number of hospitalizations was 396.4 for acute coronary syndrome, 598.6 for heart failure, and 334.6 for stroke. The daily mean number of hospitalizations for heart failure and stroke was higher in the 15 days following each attack compared with the reference periods. However, multivariate analysis showed no significant variation in the risk of hospitalization in the days following the attacks.

Interpretation: Watching events unfold on television, no matter how dramatic, was not a sufficiently potent trigger for cardiovascular disease, although it may have led to an increase in hospitalizations for stress or anxiety. The 2015 and 2016 terrorist attacks do not seem to have had any measurable short-term impact on hospitalizations for cardiovascular disease either in the Paris and Nice regions or in the rest of France.

Keywords: cardiovascular disease; hospitalization; terrorist attacks.

Figure 1

Daily number of hospitalization for ACS, HF, and stroke over 2009–2016 for France, Paris region, and Nice region. Notes: Dashed and plain black lines represent, respectively, long-term trends, and long-term trends plus seasonal variations, as estimated by the model. Different scales are used for each cardiovascular cause and geographical area. Abbreviations: ACS, acute coronary syndrome; HF, heart failure.

Figure 2

Specific variation in daily hospitalization rates in the 15 days following the terrorist attacks. Notes: Black lines represent adjusted variations (percentage change between modeled daily counts and background rate, given usual 2009–2016 variations) and gray lines indicate 95% confidence intervals. Different scales are used for each attack. Abbreviations: ACS, acute coronary syndrome; HF, heart failure.