Wu, J, Mamas, M ORCID: https://orcid.org/0000-0001-9241-8890, Rashid, M ORCID: https://orcid.org/0000-0001-9725-1583, Weston, C, Hains, J, Luescher, T, de Belder, MA, Deanfield, JE and Gale, CP (2020) Patient response, treatments and mortality for acute myocardial infarction during the COVID-19 pandemic. European Heart Journal - Quality of Care and Clinical Outcomes.

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Abstract

AIM: COVID-19 might have affected the care and outcomes of hospitalised acute myocardial infarction (AMI). We aimed to determine whether the COVID-19 pandemic changed patient response, hospital treatment and mortality from AMI. METHODS AND RESULTS: Admission were classified as non ST-elevation myocardial infarction (NSTEMI) or STEMI at 99 hospitals in England through live feeding from the Myocardial Ischaemia National Audit Project between 1st January, 2019 and 22nd May, 2020. Time series plots were estimated using a 7-day simple moving average, adjusted for seasonality. From 23rd March, 2020 (UK lockdown) median daily hospitalisations decreased more for NSTEMI (69 to 35; IRR 0.51, 95% CI 0.47-0.54) than STEMI (35 to 25; IRR 0.74, 95% CI 0.69-0.80) to a nadir on 19th April, 2020. During lockdown, patients were younger (mean age 68.7 years vs. 66.9 years), less frequently diabetic (24.6% vs. 28.1%) or had cerebrovascular disease (7.0% vs. 8.6%). STEMI more frequently received primary PCI (81.8% vs 78.8%%), thrombolysis was negligible (0.5% vs. 0.3%), median admission-to-coronary angiography duration for NSTEMI decreased (26.2 vs. 64.0 hours), median duration of hospitalisation decreased (4 to 2 days), secondary prevention pharmacotherapy prescription remained unchanged (each >94.7%). Mortality at 30 days increased for NSTEMI (from 5.4% to 7.5%; OR 1.41, 95% CI 1.08-1.80), but decreased for STEMI (from 10.2% to 7.7%; OR 0.73, 95% CI 0.54-0.97). CONCLUSIONS: During COVID-19, there was a substantial decline in admissions with AMI. Those who presented to hospital were younger, less co-morbid and, for NSTEMI, had higher 30-day mortality.

Item Type: Article
Additional Information: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions please email: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) This is a pre-copyedited, author-produced version of an article accepted for publication in European Heart Journal - Quality of Care and Clinical Outcomes following peer review. The version of record is available online at: https://academic.oup.com/ehjqcco/advance-article/doi/10.1093/ehjqcco/qcaa062/5878960 https://doi.org/10.1093/ehjqcco/qcaa062
Uncontrolled Keywords: myocardial infarction, acute, angiogram, non-st elevated myocardial infarction, st segment elevation myocardial infarction, myocardial ischemia, cerebrovascular disorders, pharmacotherapy, diabetes mellitus, thrombolytic therapy, hospitalization, length of stay, mortality, secondary prevention, seasonal variation, covid-19, coronavirus pandemic
Subjects: R Medicine > R Medicine (General)
R Medicine > RA Public aspects of medicine
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Related URLs:
Depositing User: Symplectic
Date Deposited: 14 Aug 2020 14:21
Last Modified: 14 Aug 2020 14:21
URI: https://eprints.keele.ac.uk/id/eprint/8548

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