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Effect of COVID-19 Pandemic Lockdown on Emergency Medical Service Utilisation, and Percutaneous Coronary Intervention
Kawa Haji1, Sara Vogrin2, Nicholas D'Elia3
1Department of Cardiology, Western Health, Vic, Australia; Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia.
Insights
During COVID-19 lockdowns, emergency medical service use for acute coronary syndrome increased in Victoria, Australia. Percutaneous coronary intervention volumes remained stable, with no negative impact on patient outcomes.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- International COVID-19 lockdowns saw reduced acute coronary syndrome (ACS) admissions and percutaneous coronary intervention (PCI) volumes.
- The impact of these lockdowns on emergency medical service (EMS) utilization and PCI volume in Australia remains under-described.
Purpose of the Study:
- To investigate the effect of the initial COVID-19 lockdown on EMS utilization, PCI volume, and patient outcomes in Victoria, Australia.
- To compare these metrics during lockdown with pre-lockdown, post-lockdown, and the prior year periods.
Main Methods:
- Analysis of linked data from the Victorian Cardiac Outcomes Registry (VCOR) and Ambulance Victoria EMS registry.
- Comparison of PCI volume, 30-day major adverse cardiovascular and cerebrovascular events (MACCE), and EMS utilization across four distinct time periods.
- Interrupted time series analysis to assess PCI trends.
Main Results:
- EMS utilization for ACS was significantly higher during lockdown (39.4%) compared to other periods (p<0.01).
- Median daily PCI volumes remained consistent across all periods (p>0.05).
- Door-to-procedure times for ACS indications were shorter during lockdown (p<0.05), and 30-day MACCE odds were lower compared to pre-lockdown and prior year periods (p<0.05).
Conclusions:
- Contrary to international trends, Victorian EMS utilization for ACS increased during lockdown, while PCI volumes were maintained.
- No adverse effect on 30-day MACCE was observed during the lockdown period.
- The public health response in Victoria did not compromise cardiovascular care quality for PCI patients.
Background:
Acute coronary syndrome (ACS) admissions and percutaneous coronary intervention (PCI) volume declined during periods of COVID-19 lockdown internationally in 2020. The effect of lockdown on emergency medical service (EMS) utilisation, and PCI volume during the initial phase of the pandemic in Australia has not been well described.
Method:
We analysed data from the Victorian Cardiac Outcomes Registry (VCOR), a state-wide PCI registry, linked with the Ambulance Victoria EMS registry. PCI volume, 30-day major adverse cardiovascular and cerebrovascular events (MACCE; composite of mortality, myocardial infarction, stent thrombosis, unplanned revascularisation, and stroke), and EMS utilisation were compared over four time periods: lockdown (26 Mar 2020-12 May 2020); pre-lockdown (26 Feb 2020-25 Mar 2020); post-lockdown (13 May 2020-10 Jul 2020); and the year prior (26 Mar 2019-12 May 2019). Interrupted time series analysis was performed to assess PCI trends within and between consecutive periods.
Results:
The EMS utilisation for ACS during lockdown was higher compared with other periods: lockdown 39.4% vs pre-lockdown 29.7%; vs post-lockdown 33.6%; vs year prior 27.1%; all p<0.01. Median daily PCI cases were similar: 31 (IQR 10, 38) during lockdown; 39 (15, 49) pre-lockdown; 39.5 (11, 44) post-lockdown; and, 42 (10, 49) the year prior; all p>0.05. Median door-to-procedure time for ACS indication during lockdown was shorter at 3 hours (1.2, 20.6) vs pre-lockdown 3.9 (1.7, 21); vs post-lockdown 3.5 (1.5, 21.26); and, the year prior 3.5 (1.5, 23.7); all p<0.05. Lockdown period was associated with lower odds for 30-day MACCE compared to pre-lockdown (odds ratio [OR] 0.55 [0.33-0.93]; p=0.026); post-lockdown (OR 0.66; [0.40-1.06]; p=0.087); and the year prior (OR 0.55 [0.33-0.93]; p=0.026).
Conclusions:
Contrary to international trends, EMS utilisation for ACS increased during lockdown but PCI volumes remained similar throughout the initial stages of the pandemic in Victoria, with no observed adverse effect on 30-day MACCE during lockdown. These data suggest that the public health response in Victoria was not associated with poorer quality cardiovascular care in patients receiving PCI.
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