The impact of coronavirus disease 2019 on acute coronary syndrome: Differences between epidemic waves
Vincenzo Sucato1, Giusy Sausa1, Grazia Gambino1
1Division of Cardiology, University Hospital Paolo Giaccone, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Italy.
Insights
The COVID-19 pandemic significantly impacted acute coronary syndrome (ACS) patient care, with the first wave showing the greatest management challenges due to hospital unpreparedness and patient fear. Subsequent waves saw increased hospitalizations and changes in treatment times and outcomes.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic has had indirect effects on cardiovascular health systems, particularly for patients with Acute Coronary Syndrome (ACS).
- Limited attention has been given to the pandemic's impact on ACS management across different epidemic waves.
- Understanding these impacts is crucial for optimizing cardiovascular care during health crises.
Purpose of the Study:
- To compare epidemiological, clinical, and management differences in patients hospitalized for ACS across four COVID-19 epidemic waves.
- To highlight the burden of the pandemic on the management of Acute Coronary Syndrome.
- To analyze changes in ACS patient outcomes and healthcare delivery during the pandemic.
Main Methods:
- A retrospective observational study of 98 patients admitted to a Coronary Intensive Care Unit (CICU) for ACS between March 2020 and March 2022.
- Patients were divided into four groups, each representing a distinct COVID-19 epidemic wave.
- Data on hospitalization rates, treatment times (door-to-balloon), length of stay, and mortality were analyzed.
Main Results:
- Hospitalizations for ACS increased progressively, with a 178% rise in the third wave compared to the first (p=0.003).
- Non-ST-Elevation Myocardial Infarction (NSTEMI) hospitalizations increased by 900% in the third wave.
- Longer door-to-balloon times were observed in the third wave; average hospital stay and mortality varied across waves, with the highest mortality in the fourth wave (9.5%).
Conclusions:
- The management of ACS was most severely affected during the initial pandemic wave due to hospital unpreparedness and patient reluctance to seek care.
- Fear of infection and system unpreparedness significantly hampered ACS care delivery.
- Pandemic waves influenced ACS hospitalization rates, treatment delays, and patient mortality, necessitating adaptive strategies in cardiovascular care.
Introduction:
Since the beginning of the COronaVIrus Disease 2019 (COVID-19) pandemic, poor attention has been paid to the indirect effects of the pandemia on cardiovascular health system, in particular in patients with Acute Coronary Syndrome (ACS). The aims of this study is to compare possible epidemiological, clinical and management differences between the four epidemic waves in groups of patients hospitalized for ACS with a view to highlighting the burden of the pandemic on the management of this syndrome.
Materials And Methods:
In this retrospective observational study we included 98 patients admitted to Coronary Intensive Care Unit (CICU) for ACS between March 2020 and March 2022, who underwent revascularization procedure using percutaneous coronary angioplasty (PCI). The patients examined were divided into four groups representative of the four epidemic waves that affected our country.
Results:
The rate of hospitalization for ACS increased progressively to a 178 % increase in the third wave compared to the first (p = 0.003), with an increase of 900 % if we consider only Non-ST-Elevation Myocardial Infarction (NSTEMI) (representing 54 % of the ACS diagnoses of the third group against 14.3 % in the first). Longer door-to-balloon times were recorded in the third wave for the increased presence of NSTEMI. The average hospital stay was lower in the third wave with 5 ± 2 days (p = 0.007) as well as mortality (5.1 % in the third wave; the highest in the fourth wave with 9.5 %).
Conclusions:
The study show that the management of ACS suffered most from the indirect effects of the pandemic during the first wave, both because of the unpreparedness of hospital facilities and because of the fear of infection that has dissuaded people from asking for help.
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