Skip to main content Accessibility help

Burden of Cardiovascular Morbidity and Mortality Following Humanitarian Emergencies: A Systematic Literature Review

  • Kaitlin G. Hayman (a1) (a2), Davina Sharma (a1), Robert D. Wardlow (a3) and Sonal Singh (a4)



The global burden of cardiovascular mortality is increasing, as is the number of large-scale humanitarian emergencies. The interaction between these phenomena is not well understood. This review aims to clarify the relationship between humanitarian emergencies and cardiovascular morbidity and mortality.


With assistance from a research librarian, electronic databases (PubMed, Scopus, CINAHL, and Global Health) were searched in January 2014. Findings were supplemented by reviewing citations of included trials. Observational studies reporting the effect of natural disasters and conflict events on cardiovascular morbidity and mortality in adults since 1997 were included. Studies without a comparison group were not included. Double-data extraction was utilized to abstract information on acute coronary syndrome (ACS), acute decompensated heart failure (ADHF), and sudden cardiac death (SCD). Review Manager 5.0 (Version 5.2, The Nordic Cochrane Centre; Copenhagen Denmark,) was used to create figures for qualitative synthesis.


The search retrieved 1,697 unique records; 24 studies were included (17 studies of natural disasters and seven studies of conflict). These studies involved 14,583 cardiac events. All studies utilized retrospective designs: four were population-based, 15 were single-center, and five were multicenter studies. Twenty-three studies utilized historical controls in the primary analysis, and one utilized primarily geographical controls.


Conflicts are associated with an increase in long-term morbidity from ACS; the short-term effects of conflict vary by study. Natural disasters exhibit heterogeneous effects, including increased occurrence of ACS, ADHF, and SCD.


In certain settings, humanitarian emergencies are associated with increased cardiac morbidity and mortality that may persist for years following the event. Humanitarian aid organizations should consider morbidity from noncommunicable disease when planning relief and recuperation projects.

Hayman KG , Sharma D , Wardlow RD II , Singh S . Burden of Cardiovascular Morbidity and Mortality Following Humanitarian Emergencies: A Systematic Literature Review. Prehosp Disaster Med. 2015;30(1):1-9 .


Corresponding author

Correspondence: Kaitlin Hayman, MD, MPH Division of Emergency Medicine London Health Sciences Centre 800 Commissioners Road E London, Ontario, Canada, N6A 5W9 E-mail


Hide All

Conflicts of interest: none



Hide All
1. Forouzanfar, MH, Moran, AE, Flaxman, AD, et al. Assessing the global burden of ischemic heart disease, part 2: analytic methods and estimates of the global epidemiology of ischemic heart disease in 2010. Global Heart. 2012;7(4):331-342.
2. Demaio A, JJ, Horn, R, de Courten, M, Tellier, S. Non-communicable diseases in emergencies: a call to action. PloS Current. 2013;5.
3. Strike, PC, Steptoe, A. Behavioral and emotional triggers of acute coronary syndromes: a systematic review and critique. Psychosomatic medicine. 2005;67(2):179-186.
4. Carroll D, ES, Tilling, K, Macleod, J, Smith, GD. Admissions for myocardial infarction and World Cup football: database survey. BMJ. 2002;325(7378):1439-1442.
5. Aoki, T, Fukumoto, Y, Yasuda, S, et al. The Great East Japan Earthquake disaster and cardiovascular diseases. Eur Heart J. 2012;33(22):2796-2803.
6. Bergovec, M, Heim, I, Vasilj, I, Jembrek-Gostovic, M, Bergovec, M, Strnad, M. Acute coronary syndrome and the 1992-1995 war in Bosnia and Herzegovina: a 10-year retrospective study. Mil Med. 2005;170(5):431-434.
7. Lo, CK, Mertz, D, Loeb, M. Newcastle-Ottawa Scale: comparing reviewers’ to authors’ assessments. BMC Med Res Methodol. 2014;14:45.
8. The Conchrane Collaboration. Review Manager (RevMan). 5.2 ed. Copenhagen, Denmark: The Nordic Cochrane Centre; 2012.
9. Vasilj, I, Bergovec, M, Kvesic, A, et al. Acute coronary syndrome frequency in Western Herzegovina over the fifteen year period (1987-2001). Coll Antropol. 2006;30(4):915-919.
10. Miric, D, Giunio, L, Bozic, I, Fabijanic, D, Martinovic, D, Culic, V. Trends in myocardial infarction in Middle Dalmatia during the war in Croatia. Mil. Med. 2001;166(5):419-421.
11. Zubaid, M, Suresh, CG, Thalib, L, Rashed, W. Could missile attacks trigger acute myocardial infarction? Acta Cardiol. 2006;61(4):427-431.
12. Chi, JS, Speakman, MT, Poole, WK, Kandefer, SC, Kloner, RA. Hospital admissions for cardiac events in New York City after September 11, 2001. Am J Cardiol. 2003;92(1):61-63.
13. Feng, J, Lenihan, DJ, Johnson, MM, Karri, V, Reddy, CV. Cardiac sequelae in Brooklyn after the September 11 terrorist attacks. Clin Cardiol. 2006;29(1):13-17.
14. Allegra, JR, Mostashari, F, Rothman, J, Milano, P, Cochrane, DG. Cardiac events in New Jersey after the September 11, 2001, terrorist attack. J Urban Health. 2005;82(3):358-363.
15. Gold, LS, Kane, LB, Sotoodehnia, N, Rea, T. Disaster events and the risk of sudden cardiac death: a Washington State investigation. Prehosp Disaster Med. 2007;22(4):313-317.
16. Brown, DL. Disparate effects of the 1989 Loma Prieta and 1994 Northridge earthquakes on hospital admissions for acute myocardial infarction: importance of superimposition of triggers. Am Heart J. 1999;137(5):830-836.
17. Watanabe, H, Kodama, M, Okura, Y, et al. Impact of earthquakes on Takotsbubo cardiomyopathy. JAMA. 2005;294(3):305-307.
18. Aoki, T, Takahashi, J, Fukumoto, Y, et al. Effect of the Great East Japan Earthquake on cardiovascular diseases. Circ J. 2013;77(2):490-493.
19. Chan, C, Elliott, J, Troughton, R, et al. Acute myocardial infarction and stress cardiomyopathy following the Christchurch earthquakes. PloS one. 2013;8(7):e68504.
20. Tsai, CH, Lung, FW, Wang, SY. The 1999 Ji-Ji (Taiwan) earthquake as a trigger for acute myocardial infarction. Psychosomatics. 2004;45(6):477-482.
21. Tsuchida, M, Kawashiri, MA, Teramoto, R, et al. Impact of severe earthquake on the occurrence of acute coronary syndrome and stroke in a rural area of Japan. Circ J. 2009;73(7):1243-1247.
22. Nozaki, E, Nakamura, A, Abe, A, et al. Occurrence of cardiovascular events after the 2011 Great East Japan Earthquake and tsunami disaster. Int Heart J. 2013;54(5):247-253.
23. Nakamura, A, Nozaki, E, Fukui, S, Endo, H, Takahashi, T, Tamaki, K. Increased risk of acute myocardial infarction after the Great East Japan Earthquake. Heart Vessels. 2014;29(2):206-212.
24. Gautam, S, Menachem, J, Srivastav, SK, Delafontaine, P, Irimpen, A. Effect of Hurricane Katrina on the incidence of acute coronary syndrome at a primary angioplasty center in New Orleans. Disaster Med Public Health Prep. 2009;3(3):144-150.
25. Peters, MN, Katz, MJ, Moscona, JC, et al. Effect of Hurricane Katrina on chronobiology at onset of acute myocardial infarction during the subsequent three years. Am J Cardiol. 2013;111(6):800-803.
26. Nakamura, A, Satake, H, Abe, A, et al. Characteristics of heart failure associated with the Great East Japan Earthquake. J Cardiol. 2013;62(1):25-30.
27. Nakamura, M, Tanaka, F, Nakajima, S, et al. Comparison of the incidence of acute decompensated heart failure before and after the major tsunami in Northeast Japan. Am J Cardiol. 2012;110(12):1856-1860.
28. Yamauchi, H, Yoshihisa, A, Iwaya, S, et al. Clinical features of patients with decompensated heart failure after the Great East Japan Earthquake. Am J Cardiol. 2013;112(1):94-99.
29. Kitamura, T, Kiyohara, K, Iwami, T. The Great East Japan Earthquake and out-of-hospital cardiac arrest. NEJM. 2013;369(22):165-167.
30. Ogawa, K, Tsuji, I, Shiono, K, Hisamichi, S. Increased acute myocardial infarction mortality following the 1995 Great Hanshin-Awaji earthquake in Japan. Int J Epidemiol. 2000;29(3):449-455.
31. Wells, GA SB, O'Connell, D, Peterson, J, Welch, V, Losos, M, Tugwell, P. Newcastle-Ottawa Quality Assessment Scale Cohort Studies. Accessed April 19, 2014.
32. Lin LY, WC, Liu, YB, Ho, YL, Liau, CS, Lee, YT. Derangement of heart rate variability during a catastrophic earthquake: a possible mechanism for increased heart attacks. Pacing Clin Electrophysiol. 2001;24(11):1596-1601.
33. Nakano, M, Kondo, M, Wakayama, Y, et al. Increased incidence of tachyarrhythmias and heart failure hospitalization in patients with implanted cardiac devices after the Great East Japan Earthquake disaster. Circ J. 2012;76(5):1283-1285.
34. Nishizawa, M, Hoshide, S, Shimpo, M, Kario, K. Disaster hypertension: experience from the Great East Japan Earthquake of 2011. Current Hypertens Rep. 2012;14(5):375-381.
35. Lavie, CJ, Gerber, TC, Lanier, WL. Hurricane Katrina: the infarcts beyond the storm. Disaster Med Public Health Prep. 2009;3(3):131-135.
36. OFDA/CRED. 2013 Disasters in Numbers. Accessed April 18, 2014.


Type Description Title
Supplementary materials

Hayman Supplementary Material

 Word (15 KB)
15 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed