Impact of COVID-19 pandemic lockdown on myocardial infarction care
Timo Schmitz1,2, Christa Meisinger3,4, Inge Kirchberger3,4
1Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Augsburg, Germany. timo.schmitz@med.uni-augsburg.de.
Insights
The COVID-19 lockdown significantly reduced acute myocardial infarction (AMI) hospitalizations by 44%, with patients reporting fear of infection as the primary stressor, not lockdown restrictions. Door-to-device times also improved during this period.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic and subsequent lockdowns have raised concerns about their impact on cardiovascular care.
- Understanding these effects is crucial for maintaining essential healthcare services during public health crises.
Purpose of the Study:
- To assess the influence of the COVID-19 lockdown on acute myocardial infarction (AMI) care in a German registry.
- To identify patient-reported stressors during the lockdown period preceding AMI.
Main Methods:
- Analysis of AMI cases (n=210) from the KORA Myocardial Infarction Registry in Augsburg, Germany (Feb 10 - May 19, 2020).
- Patients categorized into pre-lockdown, strict lockdown, and attenuated lockdown groups.
- Patient survey on stress and fears in the 4 weeks prior to AMI.
Main Results:
- AMI rates decreased by 44% during strict lockdown and 17% during attenuated lockdown compared to pre-lockdown.
- This decline was observed in both STEMI and NSTEMI patients, irrespective of sex or age.
- Door-to-device times improved significantly (70-80% reduction) during lockdown periods.
- Patients' primary stressor was fear of SARS-CoV-2 infection, not lockdown restrictions.
Conclusions:
- The COVID-19 lockdown markedly impacted AMI care, even in regions with low COVID-19 incidence.
- Fear of infection appears to be the main driver for reduced AMI hospitalizations.
- Despite reduced admissions, treatment times improved, suggesting potential benefits in focused care during crises.
Abstract:
The aim of this study was to evaluate the impact of the COVID-19 pandemic lockdown on acute myocardial infarction (AMI) care, and to identify underlying stressors in the German model region for complete AMI registration. The analysis was based on data from the population-based KORA Myocardial Infarction Registry located in the region of Augsburg, Germany. All cases of AMI (n = 210) admitted to one of four hospitals in the city of Augsburg or the county of Augsburg from February 10th, 2020, to May 19, 2020, were included. Patients were divided into three groups, namely pre-lockdown, strict lockdown, and attenuated lockdown period. An additional survey was conducted asking the patients for stress and fears in the 4 weeks prior to their AMI. The AMI rate declined by 44% in the strict lockdown period; in the attenuated lockdown period the rate was 17% lower compared to the pre-lockdown period. The downward trend in AMI rates during lockdown was seen in STEMI and NSTEMI patients, and independent of sex and age. The door-to-device time decreased by 70-80% in the lockdown-periods. In the time prior to the infarction, patients felt stressed mainly due to fear of infection with Sars-CoV-2 and less because of the restrictions and consequences of the lockdown. A strict lockdown due to the Covid-19 pandemic had a marked impact on AMI care even in a non-hot-spot region with relatively few cases of COVID-19. Fear of infection with the virus is presumably the main reason for the drop in hospitalizations due to AMI.
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