Worldwide differences of hospitalization for ST-segment elevation myocardial infarction during COVID-19: A systematic
Francesco Sofi1, Monica Dinu1, GianPaolo Reboldi2
1Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Insights
Hospital admissions for ST-elevation myocardial infarction (STEMI) decreased during the COVID-19 pandemic, but less than previously thought. Country-level differences in STEMI rates were linked to hospital bed availability, not COVID-19 spread or policies.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Conflicting reports exist regarding ST-elevation myocardial infarction (STEMI) hospitalizations during the COVID-19 pandemic.
- This study investigates factors influencing these discrepancies across different countries.
Purpose of the Study:
- To analyze STEMI hospitalization trends during the COVID-19 pandemic.
- To identify factors, including COVID-19 epidemiology and public health measures, that explain variations in STEMI admissions across countries.
Main Methods:
- A systematic review and meta-analysis of studies comparing STEMI admissions during the COVID-19 pandemic with a reference period.
- Searches conducted across major databases (MedLine, Embase, Scopus, Web-of-Science, Cochrane).
- Data extracted following PRISMA guidelines and pooled using a random-effects model.
Main Results:
- Included 79 articles covering 111,557 STEMI cases from 57 countries.
- Overall STEMI hospitalizations decreased during the pandemic (IRR 0.80; 95% CI 0.76-0.84).
- Significant heterogeneity observed; country-level differences in STEMI rates were inversely related to hospital bed availability, not COVID-19 epidemiology or public health strategies.
Conclusions:
- STEMI hospitalizations significantly decreased during the COVID-19 pandemic, though less dramatically than initially reported.
- Variability in STEMI rates across countries was not explained by COVID-19 epidemiology or containment measures.
- Healthcare organization, particularly hospital bed availability, likely influenced STEMI admission rates, highlighting the need to maintain emergency medical services during pandemics.
Background:
Discrepant data were reported about hospital admissions for ST-segment elevation myocardial infarction (STEMI) during COVID-19 pandemic. We reviewed studies reporting STEMI hospitalizations during COVID-19 pandemic, investigating whether differences in COVID-19 epidemiology or public health-related factors could explain discrepant findings in different countries.
Methods:
Search through MedLine, Embase, Scopus, Web-of-Science, Cochrane Register of Controlled Trials, of studies comparing STEMI admissions during COVID-19 pandemic with a reference period, without language restrictions, as registered in PROSPERO International Prospective Register of Systematic Reviews. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed. Data independently extracted by multiple investigators were pooled using a random-effects model. Health-related metrics were from publicly-available sources.
Results:
We included 79 articles (111,557 STEMI cases, from 57 countries). During peak COVID-19 pandemic, overall incidence rate-ratio (IRR) of STEMI hospitalizations over reference period decreased (0.80; 95% CI 0.76-0.84; p < 0.05). Although wide variations and significant heterogeneity were detected among studies (I2 = 89%; p < 0.0001), no significant differences were observed by report methodology (survey vs registry), or observation/reference period. However, large differences emerged at country level not explained by COVID-related epidemiological data, nor by public health strategies. Instead, IRRs for STEMI admissions were inversely related to hospital bed availability in each country (p < 0.05).
Conclusions:
During COVID-19 pandemic hospitalization for STEMI significantly decreased, although to a smaller extent than initially reported. Large variability emerged across countries, unrelated to COVID-related epidemiology or social containment measures. Disparities in healthcare organization likely contributed, indicating that proper organization of emergency medicine should be preserved during pandemics.
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