Delays in Presentation in Patients With Acute Myocardial Infarction During the COVID-19 Pandemic

Abstract

Background:The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has had a major impact on the behavior of patients, as well as on the delivery of healthcare services. With older and more medically vulnerable people tending to stay at home to avoid contracting the virus, it is unclear how the behavior of people with acute myocardial infarction (AMI) has changed. The aim of this study was to determine if delays in presentation and healthcare service delivery for AMI exist during the COVID-19 pandemic compared to the same period a year prior. Methods:In this single-center, retrospective study, we evaluated patients admitted with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) during early months of the COVID-19 pandemic (March 11, 2020 to April 20, 2020 compared to patients admitted with same diagnosis during the same period a year prior.Results: There were 30 and 62 patients who presented with NSTE-MI in the pandemic and pre-pandemic eras, respectively. The median pain-to-door time was significantly larger during the pandemic compared to pre-pandemic era (1,885 (880, 5,732) vs. 606 (388, 944) min, P < 0.0001). There was a significant delay in door-toreperfusion time during the pandemic with a median time of 332 (182, 581) vs. 194 (92, 329) min (P = 0.0371). There were 24 (80%) and 25 (42%) patients who presented after 12 h of pain onset in pandemic and pre-pandemic eras, respectively (P = 0.0006). There were 47 and 60 patients who presented with STEMI during the pandemic timeframe of study and pre-pandemic timeframe, respectively. The median pain-to-door time during the pandemic was significantly larger than that of the pre-pandemic (620 (255, 1,500) vs. 349 (146, 659) min, P = 0.0141). There were 22 (47%) and 14 (24%) patients who presented after 12 h of pain onset in the pandemic and prepandemic eras, respectively (P = 0.0127). There was not a significant delay in door-to-reperfusion time (P = 0.9833). There were no differences in in-hospital death, stroke, or length of hospitalization between early and late presenters, as well as between pandemic and pre-pandemic eras. Conclusions:In conclusion, this study found that patients waited significantly longer during the pandemic to seek medical treatment for AMI compared to before the pandemic, and that pandemic-specific protocols may delay revascularization for NSTEMI patients. These findings resulted in more than a threefold increase from the onset of symptoms to revascularization increasing the risks for future complications such as left ventricular dysfunction and cardiovascular death. Efforts should be made to increase patients' awareness regarding consequences of delayed presentation, and to find a balance between hospital evaluation strategies and goals of minimizing total ischemic time.

Six-Month Outcomes for COVID-19 Negative Patients with Acute Myocardial Infarction Before Versus During the COVID-19 Pandemic

“…Similarly, this hypothesis explains why the median pain-to-door time more than doubled for STEMI patients during the pandemic and increased by more than fourfold for NSTEMI patients ( Table 2 , Figure 1 ). Our findings are consistent with previous studies conducted in Europe 4 , 10 , 11 .…”

“…Beginning March 11, 2020, the Lithuanian government imposed some of the most restrictive measures compared to countries with similar infection levels. Though these protocols aided in slowing the growth of the pandemic in Lithuania, they also had immediate negative impacts on the treatment of other important diseases, such as acute myocardial infarction (AMI) 4 . As the repercussions of the pandemic are still evolving, it is the purpose of this paper to examine the 6-month outcomes of the COVID-19 pandemic lockdown in terms of major cardiovascular adverse events (MACE) among non-infected AMI patients.…”

Effects of Emergency Care-related Health Policies during the COVID-19 Pandemic in Korea: a Quasi-Experimental Study

“…Despite the designation of the SEMC, ED LOS increased in patients with AMI and stroke, probably due to the rapid increase in the number of COVID-19 confirmed patients with severe illness leading to a shortage of ICU beds. The mortality rates of emergency patients with clinically important diagnoses increased during the COVID-19 pandemic 19 20 21 22 and the length of hospital stay for patients with the diseases increased 23 24 25 26 in several countries with no relevant health policies. The in-hospital mortality rates of AMI and severe trauma, which increased during the early phase of COVID-19 outbreak, could be reduced by implementing the emergency care-related health policies.…”

Frequency of Autoantibody-Negative Type 1 Diabetes in Children, Adolescents, and Young Adults During the First Wave of the COVID-19 Pandemic in Germany

“…Admissions for health care during the pandemic have markedly declined (29-31). As a result, diagnoses were delayed and diseases were identified at an advanced stage (32,33). Therefore, during the COVID-19 pandemic, a significant increase in the frequency of ketoacidosis has been observed from different parts of the world (13)(14)(15).…”