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COVID-19 and changes in activity and treatment of ST elevation MI from a UK cardiac centre
Yang Chen1,2, Krishnaraj S Rathod2,3, Stephen Hamshere2,3
1Institute of Cardiovascular Science, University College London, UK.
Insights
COVID-19 significantly reduced emergency cardiac procedures, including percutaneous coronary interventions (PCIs) for ST-elevation myocardial infarction (STEMI). This decline in STEMI care may have led to increased indirect harm, including higher mortality and nonfatal myocardial infarction (MI).
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- COVID-19 response focused on case numbers and fatality rates, neglecting indirect health impacts.
- This study investigates changes in emergency cardiac procedures during the pandemic.
- It aims to model excess indirect morbidity and mortality from reduced cardiac care.
Purpose of the Study:
- To characterize changes in emergency activity at a high-volume cardiac catheterization center.
- To model potential excess indirect morbidity and mortality due to COVID-19 disruptions.
Main Methods:
- Retrospective cohort study at St. Bartholomew's Hospital, UK.
- Included patients admitted with acute coronary syndrome (ACS) via the Heart Attack Centre (HAC) pathway.
- Data collected for March 16th - May 16th, 2020, compared to preceding years.
Main Results:
- A 28% decrease in primary percutaneous coronary interventions (PCIs) for ST-elevation myocardial infarction (STEMI).
- A 36% reduction in Heart Attack Centre (HAC) pathway activations.
- Estimated excess harm from 'missing STEMIs' includes a 1.3% increase in mortality, 1.9% in nonfatal MI, and 4.5% in recurrent ischemia.
Conclusions:
- Emergency cardiac activity, particularly for STEMI, significantly decreased during the first COVID-19 wave.
- The findings highlight substantial indirect harm from reduced cardiovascular care.
- Data can inform future cardiovascular modeling and policy actions related to pandemics.
Background:
The international healthcare response to COVID-19 has been driven by epidemiological data related to case numbers and case fatality rate. Second order effects have been less well studied. This study aimed to characterise the changes in emergency activity of a high-volume cardiac catheterisation centre and to cautiously model any excess indirect morbidity and mortality.
Method:
Retrospective cohort study of patients admitted with acute coronary syndrome fulfilling criteria for the heart attack centre (HAC) pathway at St. Bartholomew's hospital, UK. Electronic data were collected for the study period March 16th - May 16th 2020 inclusive and stored on a dedicated research server. Standard governance procedures were observed in line with the British Cardiovascular Intervention Society audit.
Results:
There was a 28% fall in the number of primary percutaneous coronary interventions (PCIs) for ST elevation myocardial infarction (STEMI) during the study period (111 vs. 154) and 36% fewer activations of the HAC pathway (312 vs. 485), compared to the same time period averaged across three preceding years. In the context of 'missing STEMIs', the excess harm attributable to COVID-19 could result in an absolute increase of 1.3% in mortality, 1.9% in nonfatal MI and 4.5% in recurrent ischemia.
Conclusions:
The emergency activity of a high-volume PCI centre was significantly reduced for STEMI during the peak of the first wave of COVID-19. Our data can be used as an exemplar to help future modelling within cardiovascular workstreams to refine aggregate estimates of the impact of COVID-19 and inform targeted policy action.
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