Association Between Positive Troponin and Fear of Earthquakes: A Retrospective Study

Introduction The association between natural disasters and cardiovascular events has been well-established. However, the impact of earthquakes on cardiac health, and the role of fear in this association, remains unclear. This study aims to examine the association between positive troponin levels, indicating cardiac ischemia, and fear of earthquakes among Emergency Room patients at a referral center in Beirut, Lebanon. Materials and methods This is a retrospective study conducted on patients who presented to the Emergency Room with suspected cardiac symptoms and were ordered a troponin level after the Kahramanmaras earthquake that occurred on the sixth of February 2023 and affected many neighboring countries, including Lebanon. A control group was taken from the same period in 2022 (January-February) and from the period prior to the earthquake (January up to 6 February 2023). Patients were divided into three groups: the first group (group 1) comprised patients who presented during January and February 2022 (period 1). The second group (group 2) included patients who presented from January up to the sixth of February 2023, when the Kahramanmaras earthquake occurred (period 2). The third group (group 3) consisted of patients who presented after the earthquake until the end of February 2023 (period 3). Patients who consented to participate in the study were sent a questionnaire to assess their Fear of Earthquake Scale (FES), chief complaints, date of presentation to the Emergency Room, past medical history, and other socio-demographic data. Results Our study involved 1410 participants, with 782 belonging to group 1, 470 to group 2, and 158 to group 3. The mean age was 62.96 ± 17.87 for the total population and 63.9 ± 18.49 for patients of group 3. The number of positive troponin results was higher during period 3 (62% of participants) in comparison to period 2 and 1 (22.1% and 28.5% of participants respectively) (p<0.001). Positive troponin was significantly more common among patients who are non-smokers (53%, p-value <0.001), with a negative family history of premature cardiac diseases (93.9%, p-value <0.05), previously healthy (46.9%, p-value <0.001) and presenting to the Emergency Room for dyspnea or palpitations (17.3% each, p-value <0.001). In addition, patients who tested positive for troponin had a higher mean FES (27.89 ± 1.23 versus 20.47 ± 6.02) and a higher mean age (71.07 ± 14.33 versus 52.25 ± 18.69) in comparison to those who tested negative for troponin (p-value <0.05). Conclusion This study suggests that fear of earthquakes may be associated with cardiac ischemia, as indicated by positive troponin levels. Healthcare providers should be aware of the potential impact of natural disasters on cardiovascular health and take measures to address patients' fears and concerns.