Here comes the Christmas coronary, and other holiday health hazards

Santa comes this time each year, but so do many illnesses and conditions. The holidays are accompanited by a spike in frequency of health problems great and small, from the common cold to the fatal heart attack.

“Every year, during the Christmas/New Year’s holiday season, millions of Americans abruptly change their patterns of traveling, eating, drinking, exercising, working, and vacationing,” wrote investigators in a 2004 article in Circulation. (The article’s subtitle was “The Holidays as a Risk Factor for Death.”)

The authors noted that these large-scale behavioral changes may affect patient health, including cardiac mortality. “Some patients might inappropriately delay seeking necessary medical treatment until after the holidays; others who are traveling might take longer than usual to find competent medical help.”

Here’s a rundown of some of the holiday health hazards coming to an exam room or emergency department (ED) near you.

Respiratory ills and deaths
Visits to the ED for flu-like illnesses (with the chief complaint “cough”) peak during the Christmas-New Year period, “specifically between December 26 and January 2,” according to one study. Compared with the rest of the year, visits for flu-like illnesses nearly double during this period.

Respiratory deaths increase, too—except on Christmas day. Between December 19 and 24, respiratory deaths rose by 49% over the annual average, researchers in the United Kingdom reported. However, respiratory admissions fell by 18% below trend on Christmas Day. Respiratory deaths then immediately increased above trend, by 5.9% on December 26 and 12.9% on December 27.

Cardiac and other mortalities
It’s not just respiratory deaths that peak during Yuletide. A spike in mortality from cardiac and other diseases also occurs between Christmas and New Year’s.

“This spike persists after adjusting for trends and seasons and is particularly large for individuals who are dead on arrival at a hospital, die in the emergency department, or die as outpatients,” wrote the authors in the Circulation article cited above. “For this group during the holiday period, 4.65% (±0.30%; 95% confidence interval [CI], 4.06% to 5.24%) more cardiac and 4.99% (±0.42%; 95% CI, 4.17% to 5.81%) more noncardiac deaths occur than would be expected if the holidays did not affect mortality.”

Cardiac and noncardiac deaths for these individuals (dead on arrival/die in the ED/die as outpatients) peak on Christmas Day and again on New Year’s Day.

Further, “The excess in holiday mortality is growing proportionately larger over time, both for cardiac and noncardiac mortality,” the authors wrote.

Heart failure spikes
Emergency department visits for heart failure increase by 23% between December 25 to January 7 compared to the rest of the year—an even greater increase than that reported for sudden cardiac death, according to a 2008 study.

Interestingly, heart failure visits go up even higher in the days after each holiday, increasing by 33% between December 26-29 and 30% between January 2-5.

Suicide and psychiatric illness
Popular wisdom holds that people who are lonely and depressed during the holidays are more likely to sink deeper into mental illness, with a corresponding increase in suicide. Not quite true. In fact, Christmas might exert a protective effect from psychopathology—albeit with a rebounding increase after the holidays.

Despite a general worsening of mood among individuals and an increase in alcohol-related fatalities, “there appears to be a decrease during the holiday in the overall utilization of psychiatric emergency services and admissions, self-harm behavior, and suicide attempts/completions,” one meta-analysis found.

However, a rebound effect occurs just after the holidays, with a large increase in suicide rates in the new year. The authors described this as “a concerning pattern that is relevant for both psychiatrists and primary-care clinicians.”

Pointers for patients
What, if anything, can be done to prevent these deaths and illnesses? An editorial in Circulation on “The ‘Merry Christmas Coronary’ and ‘Happy New Year Heart Attack’ Phenomenon” offers several suggestions that can be modified for many types of patients:

1. Instruct patients to avoid delay in seeking medical attention, should symptoms occur.
2. Examine patients yourself, if possible, rather than relying on health-care providers not familiar with your patients.
3. Critical care and emergency departments should be adequately staffed, and the staff should be advised about a potential increase in cases during the holiday season.
4. Instruct patients to avoid exacerbating triggers, including excess physical exertion (especially shoveling snow), overeating, lack of sleep, emotional stress, illegal drugs, and anger. Also recommend they avoid excess salt and alcohol intake.
5. Modify and treat known risk factors (eg, hypertension, smoking, diabetes, dyslipidemia).
6. Consider prophylactic treatment (eg, aspirin or beta-blockers for cardiac patients).
7. Instruct patients to avoid exposure to severely cold temperatures.
8. Instruct patients to avoid participating in outdoor activities on days when air pollution alerts are issued and to avoid inhaling smoke from wood-burning fireplaces.
9. Consider flu shots where appropriate.