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Factors Underlying Reduced Hospitalizations for Myocardial Infarction During the COVID-19 Pandemic.

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Hospitalizations for acute myocardial infarction (AMI) dropped during COVID-19. Early declines were due to patients avoiding care, while later decreases reflect a long-term trend, with 5% fewer AMI encounters overall.

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Area of Science:

  • Cardiovascular Medicine
  • Public Health
  • Epidemiology

Background:

  • Hospital encounters for acute myocardial infarction (AMI) significantly decreased during the COVID-19 pandemic.
  • The reasons for this decline, including care avoidance, excess mortality, behavioral changes, or pre-existing trends, remain debated.
  • Understanding these drivers is crucial for public health preparedness and cardiovascular care.

Purpose of the Study:

  • To investigate the underlying factors contributing to the changing incidence of AMI hospital encounters during the COVID-19 pandemic.
  • To differentiate between care avoidance, excess mortality, and secular trends as explanations for the observed decline in AMI hospitalizations.

Main Methods:

  • A cross-sectional study analyzed traditional Medicare claims from January 2016 to June 2023, encompassing over 2.85 billion patient-months.
  • Rates of AMI hospital encounters (emergency department visits, observation stays, inpatient admissions) were calculated per capita.
  • Observed rates were compared to expected rates, adjusting for population characteristics and the pre-pandemic (2016-2019) temporal trend.

Main Results:

  • In June 2023, AMI hospital encounters were 20% lower than in June 2019.
  • Early pandemic AMI rates inversely correlated with COVID-19 deaths and mirrored trends in other acute conditions, suggesting care avoidance.
  • By June 2023, an estimated 5% fewer AMI hospital encounters occurred than expected, with excess deaths explaining little of the reduction.

Conclusions:

  • The initial reduction in AMI hospital encounters during the pandemic was likely driven by patients avoiding medical care.
  • Ongoing reductions through June 2023 appear to be influenced by a pre-existing downward trend in AMI incidence.
  • The study highlights the complex interplay of behavioral and epidemiological factors affecting acute cardiovascular event hospitalizations during a public health crisis.