Early Observations During the COVID-19 Pandemic in Cardiac Catheterization Procedures for ST-Elevation Myocardial Infarction Across Ontario

Natarajan, Madhu K.; Wijeysundera, Harindra C.; Oakes, G.; Cantor, Warren J.; Miner, Steven E.S.; Welsford, Michelle; Cheskes, Sheldon; May, Michel R. Le; Jeffrey, Jana; Ko, Dennis T.

doi:10.1016/j.cjco.2020.07.015

Cited by 13 publications

(16 citation statements)

References 12 publications

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“…16 , 17 Current guidelines in the province of Ontario advocate maintaining a pPCI approach during COVID-19. 19 A previous Ontario-wide study of pPCI during COVID-19 showed increases in D2B times for patients triaged from the field, however our study did not 1 . This is likely based on the pre-emptive modifications to our system to avoid delays.…”

Section: Discussioncontrasting

confidence: 63%

“…The reduction of STEMI admissions observed in Ottawa is similar to data from the province of Ontario, which demonstrated between a 18-25% reduction in STEMI cases. 1 The nadir of our STEMI admissions occurred between March 17 th – April 16 th , the period of peak COVID-19 incidence during the Ontario lockdown. Subsequently, the mean cases per month gradually rose into the re-opening time period, when incident COVID-19 cases began to fall, and public health restrictions were lifted.…”

Section: Discussionmentioning

confidence: 97%

“…

Figure 4 Summary of reports in literature demonstrating the drop in STEMI volume and relative prevalence of COVID-19. 1 , 2 , 6 , 7 , 11 , 13 , 14 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 . For each country, the total number of COVID-19 cases, the cases per million, the drop in STEMI volume by percentages and the size of the study are shown.…”

Section: Discussionmentioning

confidence: 99%

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Delays in ST-Elevation Myocardial Infarction Care During the COVID-19 Lockdown: An Observational Study

Clifford¹,

May²,

Chow³

et al. 2021

CJC Open

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Background: Management of ST-elevated myocardial infarction (STEMI) necessitates rapid reperfusion. Delays prolong myocardial ischemia and increase the risk of complications, including death. The COVID-19 pandemic may have affected management of STEMI. We evaluated the relative volume of hospitalizations and clinical time intervals within a regional STEMI system. Methods: Four hundred ninety-four patients with STEMI were grouped into prelockdown, lockdown, and reopening cohorts. Clinical, temporal, and outcome data were collected and compared among groups for R ESUM EContexte : La prise en charge de l'infarctus du myocarde avec el evation du segment ST (STEMI) n ecessite une reperfusion rapide. Tout retard de reperfusion prolonge l'isch emie myocardique et augmente le risque de complications, y compris le risque de d ecès. Il est possible que la pand emie de COVID-19 ait nui à la prise en charge du STEMI. Nous avons donc evalu e le nombre relatif d'hospitalisations et le temps ecoul e avant la reperfusion au sein d'un système r egional de traitement des STEMI. M ethodologie : Au total, 494 patients ayant pr esent e un STEMI ont et e divis es en trois cohortes : pr econfinement, confinement et During the COVID-19 pandemic, a reduction in patients presenting with ST-elevated myocardial infarction (STEMI) has been reported. 1,2 These studies lacked data on important areas including impact of the COVID-19 lockdown on STEMI care in regions with low incidence of disease, granular details regarding reperfusion management during lockdown, effect of the pandemic on STEMI care in rural regions, and patterns of STEMI volume posteCOVID-19 lockdown. It is imperative to study the effects of COVID-19 comprehensively, so that lessons can be learned for a potential second wave or future pandemics.From March 11, 2020, to August 16, 2020, the Ottawa regions recorded 2761 cases of In response to the initial outbreak, the Ontario Ministry of Health declared a state of emergency and instituted lockdown measures on March 17, 2020. 4 Various restrictions were imposed including closure of nonessential businesses, limits on social gatherings, and cancellation of elective medical procedures. 4 These interventions were successful in limiting the spread of COVID-19; however, concerns regarding an unintended impact on STEMI care were raised. 3,

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 97%

“…

Section: Discussionmentioning

confidence: 99%

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Delays in ST-Elevation Myocardial Infarction Care During the COVID-19 Lockdown: An Observational Study

Clifford¹,

May²,

Chow³

et al. 2021

CJC Open

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“…While not all centres have reported increased DTB time during the pandemic [ 13 , 14 ] DTB delays have been the dominant trend. A registry of European countries [ 15 ], analysis of hospitals across the US [ 16 ] and China [ 17 ], a Canadian provincial study [ 18 ] and a global meta-analysis [ 19 ] all found that STEMI cases decreased while delays to reperfusion increased.…”

Section: Introductionmentioning

confidence: 99%

Flattening the other curve: Reducing emergency department STEMI delays during the COVID-19 pandemic

McLaren¹,

Taher²,

Chartier³

2021

The American Journal of Emergency Medicine

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Background The COVID-19 pandemic has been associated with ST-Elevation Myocardial Infarction (STEMI) reperfusion delays despite reduced emergency department (ED) volumes. However, little is known about ED contributions to these delays. We sought to measure STEMI delays and ED quality benchmarks over the course of the first two waves of the pandemic. Study This study was a multi-centre, retrospective chart review from two urban, academic medical centres. We obtained ED volumes, COVID-19 tests and COVID-19 cases from the hospital databases and ED Code STEMIs with culprit lesions from the cath lab. We measured door-to-ECG (DTE) time and ECG-to-Activation (ETA) time during the phases of the pandemic in our jurisdiction: pre-first wave (Jan-Mar 2020), first wave (Apr-June 2020), post-first wave (July-Nov 2020), and second wave (Dec 2020 to Feb 2021). We calculated median DTE and ETA times and compared them to the 2019 baseline using Wilcox rank-sum test. We calculated the percentages of DTE ≤10 min and of ETA ≤10 min and compared them to baseline using chi-square test. We also utilized Statistical Process Control (SPC) Xbar-R charts to assess for special cause variation. Results COVID-19 cases began during the pre-wave phase, but there was no change in ED volumes or STEMI quality metrics. During the first wave ED volumes fell by 40%, DTE tripled (10.0 to 29.5 min, p = 0.016), ETA doubled (8.5 to 17.0 min, p = 0.04), and percentages for both DTE ≤10 min and ETA ≤10 min fell by three-quarters (each from more than 50%, to both 12.5%, both p < 0.05). After the first wave all STEMI quality benchmarks returned to baseline and did not significantly change during the second wave. A brief period of special cause variation was noted for DTE during the first wave. Conclusions Both DTE and ETA metrics worsened during the first wave of the pandemic, revealing how it negatively impacted the triage and diagnosis of STEMI patients. But these normalized after the first wave and were unaffected by the second wave, indicating that nurses and physicians adapted to the pandemic to maintain STEMI quality of care. DTE and ETA metrics can help EDs identify delays to reperfusion during the pandemic and beyond.

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“…Previous studies reported that these patients tended to avoid hospital visits even in true medical emergencies. [3][4][5][6] Because of these issues, the American Heart Association recommended that medical providers emphasize the importance of calling for help as soon as possible in the event of a CVD emergency. 7 Despite these challenges, there have been few investigations of patients' perspectives regarding these concerns.…”

mentioning

confidence: 99%

Patient Perspectives in the Era of Remote Medical Visits During the Coronavirus Disease (COVID-19) Pandemic　― Insights From Outpatient Care of Cardiovascular Disease ―

et al. 2021

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Background: Patient perspectives in cardiovascular diseases (CVD) are significantly associated with clinical outcomes.Methods and Results: Among 100 patients who responded to a telephone survey in a university hospital setting in Tokyo during the coronavirus disease (COVID-19) pandemic, 20% reported depressive symptoms and 33% were hesitant to contact medical staff in the event of CVD exacerbation. Interestingly, the frequency of depressive symptoms was maintained even after a decline in the number of newly COVID-19-infected patients. Conclusions:Our telemedicine practices revealed the magnitude of our patients' mental health conditions and their hesitation to contact medical facilities in the event of CVD exacerbation.

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Early Observations During the COVID-19 Pandemic in Cardiac Catheterization Procedures for ST-Elevation Myocardial Infarction Across Ontario

Cited by 13 publications

References 12 publications

Delays in ST-Elevation Myocardial Infarction Care During the COVID-19 Lockdown: An Observational Study

Delays in ST-Elevation Myocardial Infarction Care During the COVID-19 Lockdown: An Observational Study

Flattening the other curve: Reducing emergency department STEMI delays during the COVID-19 pandemic

Patient Perspectives in the Era of Remote Medical Visits During the Coronavirus Disease (COVID-19) Pandemic　― Insights From Outpatient Care of Cardiovascular Disease ―

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Early Observations During the COVID-19 Pandemic in Cardiac Catheterization Procedures for ST-Elevation Myocardial Infarction Across Ontario

Cited by 13 publications

References 12 publications

Delays in ST-Elevation Myocardial Infarction Care During the COVID-19 Lockdown: An Observational Study

Delays in ST-Elevation Myocardial Infarction Care During the COVID-19 Lockdown: An Observational Study

Flattening the other curve: Reducing emergency department STEMI delays during the COVID-19 pandemic

Patient Perspectives in the Era of Remote Medical Visits During the Coronavirus Disease (COVID-19) Pandemic ― Insights From Outpatient Care of Cardiovascular Disease ―

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Product

Resources

About

Patient Perspectives in the Era of Remote Medical Visits During the Coronavirus Disease (COVID-19) Pandemic　― Insights From Outpatient Care of Cardiovascular Disease ―