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Immediate surge in female visits to the cardiac emergency department following the economic collapse in Iceland: an observational study
  1. Guðlaug Rakel Guðjónsdóttir1,2,
  2. Már Kristjánsson1,3,
  3. Örn Ólafsson2,
  4. Davíð O Arnar4,
  5. Linn Getz5,6,
  6. Jóhann Ágúst Sigurðsson7,8,
  7. Sigurður Guðmundsson2,
  8. Unnur Valdimarsdóttir2,9
  1. 1Department of Emergency, Landspítali University Hospital, Reykjavík, Iceland
  2. 2Centre of Public Health Sciences, University of Iceland, Stapi v/Hringbraut, Reykjavík, Iceland
  3. 3Department of Infectious Diseases, Landspítali University Hospital, Reykjavík, Iceland
  4. 4Department of Cardiology and Cardiovascular Research Centre, Landspítali University Hospital, Reykjavík, Iceland
  5. 5Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
  6. 6Department of Human Resources, Landspítali University Hospital, Reykjavík, Iceland
  7. 7Department of Family Medicine, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
  8. 8Centre of Development, Primary Health Care of the Capital Area, Thönglabakki, Iceland
  9. 9Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Unnur Valdimarsdóttir, Centre of Public Health Sciences, University of Iceland, Stapi v/Hringbraut, Reykjavík 101, Iceland; unnurav{at}


Objective To study potential changes in attendance at emergency departments (ED) in Reykjavík immediately following the swift economic meltdown in Iceland in October 2008.

Methods Using electronic medical records of the National University Hospital in Reykjavík, a population-based register study was conducted contrasting weekly attendance rates at Reykjavík ED (cardiac and general ED) during 10-week periods in 2006, 2007 and 2008. The weekly number of all ED visits (major track), with discharge diagnoses, per total population at risk were used to estimate RR and 95% CI of ED attendance in weeks 41–46 (after the 2008 economic collapse) with the weekly average number of visits during weeks 37–40 (before the collapse) as reference.

Results Compared with the preceding weeks (37–40), the economic collapse in week 41 2008 was associated with a distinct increase in the total number of visits to the cardiac ED (RR 1.26; 95% CI 1.07 to 1.49), particularly among women (RR 1.41; 95% CI 1.17 to 1.69) and marginally among men (RR 1.15; 95% CI 0.96 to 1.37). A similar increase was not observed in week 41 at the general ED in 2008 or in either ED in 2007 or 2006. In week 41 2008, visits with ischaemic heart disease as discharge diagnoses (ICD-10: I20–25) were increased among women (RR 1.79; 95% CI 1.01 to 3.17) but not among men (RR 1.07; 95% CI 0.71 to 1.62).

Conclusion The dramatic economic collapse in Iceland in October 2008 was associated with an immediate short-term increase in female attendance at the cardiac ED.

  • Acute coronary syndrome
  • cardiac care
  • diagnosis
  • economic recession
  • emergency service
  • guidelines
  • heart disease
  • hospital
  • major incidents
  • population surveillance
  • psychological
  • stress

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  • Competing interests None.

  • Ethics approval Approvals for the study were obtained from the science ethics committee of Landspítali University Hospital (ref no 48/2008) and the Data Protection Authority (ref no 2008/080540).

  • Provenance and peer review Not commissioned; externally peer reviewed.