Emergency medical services evaluations for chest pain during first COVID-19 lockdown in Hollands-Midden, the
E R de Koning1, M J Boogers2, J Bosch3
1Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands. e.r.de_koning@lumc.nl.
Insights
The COVID-19 lockdown saw fewer emergency medical service evaluations for chest pain and ST-elevation myocardial infarction (STEMI). Out-of-hospital cardiac arrest (OHCA) rates remained unchanged, highlighting potential underreporting of cardiac symptoms.
Area of Science:
- Cardiology
- Public Health
- Emergency Medicine
Background:
- The COVID-19 pandemic necessitated widespread lockdowns, potentially altering healthcare-seeking behaviors.
- Concerns exist regarding indirect health effects, including delayed medical care for critical conditions.
Purpose of the Study:
- To investigate the impact of the 2020 COVID-19 lockdown on emergency medical service (EMS) utilization for cardiac events.
- To assess potential negative indirect health effects due to reduced medical care seeking.
Main Methods:
- Retrospective analysis of EMS transports for chest pain and out-of-hospital cardiac arrest (OHCA).
- Comparison of data from the initial 6 weeks of the 2020 COVID-19 lockdown with the same period in 2019 in Hollands-Midden, Netherlands.
- Evaluation of primary endpoint: number of chest pain patients; secondary endpoints: ST-elevation myocardial infarction (STEMI) and OHCA cases.
Main Results:
- A significant reduction in EMS-evaluated chest pain patients during lockdown (RR 0.88, 95% CI 0.81-0.96).
- A significant decrease in ST-elevation myocardial infarction (STEMI) cases evaluated by EMS (RR 0.52, 95% CI 0.32-0.85).
- No significant change in the incidence of out-of-hospital cardiac arrest (OHCA) (RR 1.23, 95% CI 0.83-1.83).
Conclusions:
- The first COVID-19 lockdown correlated with a significant decrease in EMS evaluations for chest pain and STEMI.
- The incidence of OHCA remained stable, suggesting varied impacts on different cardiac emergencies.
- Emphasizes the need to encourage prompt medical attention for cardiac symptoms during future public health crises.
Objective:
To assess whether the COVID-19 lockdown in 2020 had negative indirect health effects, as people seem to have been reluctant to seek medical care.
Methods:
All emergency medical services (EMS) transports for chest pain or out-of-hospital cardiac arrest (OHCA) in the Dutch region Hollands-Midden (population served > 800,000) were evaluated during the initial 6 weeks of the COVID-19 lockdown and during the same time period in 2019. The primary endpoint was the number of evaluated chest pain patients in both cohorts. In addition, the number of EMS evaluations of ST-elevation myocardial infarction (STEMI) and OHCA were assessed.
Results:
During the COVID-19 lockdown period, the EMS evaluated 927 chest pain patients (49% male, age 62 ± 17 years) compared with 1041 patients (51% male, 63 ± 17 years) in the same period in 2019, which corresponded with a significant relative risk (RR) reduction of 0.88 (95% confidence interval (CI) 0.81-0.96). Similarly, there was a significant reduction in the number of STEMI patients (RR 0.52, 95% CI 0.32-0.85), the incidence of OHCA remained unchanged (RR 1.23, 95% CI 0.83-1.83).
Conclusion:
During the first COVID-19 lockdown, there was a significant reduction in the number of patients with chest pain or STEMI evaluated by the EMS, while the incidence of OHCA remained similar. Although the reason for the decrease in chest pain and STEMI consultations is not entirely clear, more attention should be paid to the importance of contacting the EMS in case of suspected cardiac symptoms in possible future lockdowns.
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