How Will Bernie Sanders’s Heart Attack Affect His Campaign?

https://www.nytimes.com/2019/10/07/us/politics/bernie-sanders-heart-attack.html

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WASHINGTON — As Senator Bernie Sanders recuperates from the heart attack he suffered while campaigning last Tuesday in Las Vegas, he will inevitably face questions in the coming days as to whether he will continue his presidential campaign and, if so, at what pace.

Let’s start with some facts straightaway. A heart attack does not disqualify anyone from running for and holding public office. Modern medicine enabled Presidents Dwight D. Eisenhower and Lyndon B. Johnson and Vice President Dick Cheney to continue in their roles after having suffered heart attacks, as others serving in Congress or state governments have done. (It is important to note that the popular but nonspecific term “heart attack” describes an array of heart problems; one is myocardial infarction, or the death of heart muscle cells, which is what Mr. Sanders had.)

By every indication, Mr. Sanders plans to continue his campaign for the presidency, and even told staff members on a telephone call Monday that he feels more “more strongly about the need for a political revolution today than I did when I began this campaign.”

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Former Vice President Joseph R. Biden Jr., one of the race’s leading candidates, also once faced questions about his ability to serve in public office because of a serious medical problem. In 1988, as a 45-year-old senator from Delaware, he experienced a near fatal rupture of an aneurysm in an artery in his brain. Shortly after his emergency surgery for the aneurysm, he had a second one removed before it could burst. Because new cerebral aneurysms can develop years later in a tiny percentage of individuals, some experts suggested that Mr. Biden be examined for any new aneurysms when Barack Obama selected him as his running mate. At the time, Mr. Biden’s doctor said that he did not need further testing because he had recovered fully and done well for 20 years.

Mr. Sanders is certainly not the first candidate whose presidential campaign was disrupted by a medical emergency. In 1999, former Senator Bill Bradley made an unexpected visit to a hospital in the San Francisco Bay Area for atrial fibrillation, a heart rhythm abnormality, which he did not disclose until after the incident. After canceling a few events, Mr. Bradley, now 76, resumed his campaign, but he eventually dropped out of the race after losing the New Hampshire primary. A poll of New Hampshire voters revealed concern about how he had handled the disclosure of his health issue.

Still, Mr. Sanders’s case is unusual in many respects: He is a leading candidate recovering from a heart attack at age 78 who must compete in an intensely competitive primary while also holding down a demanding job as senator. Indeed, Mr. Sanders’s disruption comes amid increased pressure to bolster voter support with strong challenges from Mr. Biden and Senator Elizabeth Warren, and it is unclear at what pace Mr. Sanders will carry on his campaign.

“Bernie will be scrutinized very carefully in the next month or two for his ability to come back and campaign as vigorously as he has done in the 2016 and current presidential campaigns,” said Ed Rollins, a former adviser to President Ronald Reagan. “He’ll be looked at a little differently” for things like being tired at the end of the day or stumbling in his delivery onstage, Mr. Rollins added.

“I have never known a politician or big moneyed guy or anyone who has had a first heart attack” not consider his mortality, Mr. Rollins added. Also, Mr. Sanders “surely will think about a running mate.”

Based on the health information he and his doctor provided when he ran in 2016, it would not have been possible to predict the Vermont senator’s heart attack last week. At that time, his doctor said that Mr. Sanders was “in overall very good health” and that his ailments included gout, a mild elevation of cholesterol, diverticulitis and an underactive thyroid gland for which he took daily hormone therapy. Tests showed that Mr. Sanders’s thyroid function and electrocardiogram tests were normal and that he had no reported history of heart disease. It is not known whether Mr. Sanders has had a full medical checkup since then.

Over the long term, however, “older patients are at higher risk of recurrent cardiac events after a heart attack,” said Dr. Christopher P. Cannon, a cardiologist at Brigham and Women’s Hospital in Boston. “But Mr. Sanders appears to have few cardiac risk factors like high blood pressure and diabetes.” He pointed to data from a series of his team’s published studies that showed a one-in-five chance within five years after a first heart attack that a second one, or even stroke or death, might occur.

But such population-based statistics provide general odds and cannot necessarily be applied to an individual.

“Very few illnesses would preclude someone from holding high office,” said Dr. Jonathan S. Reiner, a cardiologist at George Washington University Hospital in Washington, who treated Mr. Cheney for serious heart disease for many years before, during and after his two terms in office. “But the public has a right to know the salient details because the ailment or treatment can affect how the candidate performs in office.”

Although there are legal protections to keep health information confidential, most candidates seeking the presidency in recent years have responded to the public demand to know and have waived that privilege.

“The public should have sufficient facts to understand the magnitude of the event and the near- and long-term prognosis for the candidate,” Dr. Reiner said. “Mr. Sanders’s campaign has released too few details to understand the medical impact of the heart attack on his health.” Not all heart attacks, for example, are of the same dimension.

Like Mr. Sanders, three other presidential candidates are also septuagenarians. Mr. Biden will be 77 next month and Ms. Warren is 70. All three have said they will release their medical records before the Iowa caucuses that begin in February, although Mr. Sanders’s incident last week may push his top rivals to disclose their records sooner.

Then there is President Trump, who is 73. He has not said whether he would release any health information before or after his third presidential medical checkup, which is expected in early 2020. While presidents are not required to have medical checkups or release findings if they have one, Mr. Trump released a detailed summary after his first presidential exam and a less detailed one after his second, earlier this year.