Cardiovascular impact of modern warfare: STEMI patterns before and during the Israel-Hamas conflict.

Authors

Hussein Sliman, Rim Kasem Ali Sliman, Amir Aker, Avinoam Shiran

Published in

Scientific reports. Jul 18, 2026. Epub Jul 18, 2026.

Abstract

Emotional stress in conflict zones may impact cardiovascular health, particularly acute coronary syndrome incidence. This retrospective study assesses the Israel-Hamas conflict's impact on ST-elevation myocardial infarction (STEMI) by comparing admissions during conflict versus previous years. Using Clalit Israeli data center records, we conducted multi-level STEMI analysis: (1) conflict period (October 2023-October 2024) versus preceding year, (2) outbreak day and subsequent week analysis, (3) comprehensive trend analysis (2013-2024), and (4) geographic distribution across nine hospitals. Sudden cardiac death (SCD) patterns were analyzed throughout 2023. The primary outcome was the comparison of STEMI incidence between conflict and non-conflict periods. Secondary outcomes included risk factors and post-STEMI left ventricular ejection fraction (LVEF). STEMI incidence increased non-significantly from 526.03 to 539.62 per 100,000 during the conflict period compared with the pre-conflict year (P = 0.85). No significant increase occurred on October 7, 2023, or during the following week compared to 2022. Geographic analysis revealed stable hospital-specific STEMI proportions (p > 0.05). SCD demonstrated minimal variation (October 2023: 6 cases; pre-conflict monthly average: 2.9 cases) and subsequently returned to baseline. Decade-long analysis revealed a gradual increase in STEMI from 377.68 per 100,000 (2013-2014) to 539.62 per 100,000 (2023-2024). LVEF improved from 46.9% to 51.8% despite a non-significant mortality increase (16.29 to 17.96 per 100,000, P = 0.2). Acute conflict-related stress did not significantly impact STEMI incidence beyond established progressive trends. These findings are consistent with, though do not prove, population-level attenuation of acute cardiovascular stress responses. The lack of significance should be interpreted with caution, given potential confounders and limited power. Continued surveillance and the inclusion of care-quality metrics in future analyses are warranted.

PMID:
42471395
Bibliographic data and abstract were imported from PubMed on 19 Jul 2026.

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