Fear of COVID-19 in Patients with Acute Myocardial Infarction

Abstract

A marked decline in myocardial infarction (AMI) hospitalizations was observed worldwide during the COVID-19 outbreak. The pandemic may have generated fear and adverse psychological consequences in these patients, delaying hospital access. The main objective of the study was to assess COVID fear through the FCV-19S questionnaire (a self-report measure of seven items) in 69 AMI patients (65 ± 11 years, mean ± SD; 59 males). Females presented higher values of each FCV-19S item than males. Older subjects (>57 years, 25th percentile) showed a higher total score with respect to those in the first quartile. The percentage of patients who responded “agree” and “strongly agree” in item 4 (“I am afraid of losing my life because of the coronavirus”) and 3 (“My hands become clammy when I think about the coronavirus”) was significantly greater in the elderly than in younger patients. When cardiovascular (CV) patients were compared to a previously published general Italian population, patients with CV disease exhibited higher values for items 3 and 4. Measures should be put in place to assist vulnerable and high CV risk patients, possibly adding psychologists to the cardiology team.

Chronological Development of Cardiovascular Disease in Times of COVID-19: A Retrospective Analysis of Hospitalized Diseases of the Circulatory System and COVID-19 Patients of a German University Hospital

“…While most of the literature only focuses on the first national “hard” lockdown, the presented study does not only confirm the development during the first national “hard” lockdown in the setting of an in-patient maximum service provider, but, beyond that, enables a comparison with the second “soft” lockdown. The findings confirm a decline in admissions of AMI, CHF and CI during the first phase of high incidence of COVID-19 and “hard” lockdown measures and expand these towards full chronological assessment [ 24 , 25 , 26 , 27 , 28 , 29 ]. The literature suggests that the initial decline in admissions was associated with the fear of getting infected during hospitalization and being confronted with overloaded care structures [ 24 , 25 , 27 ].…”

“…The findings confirm a decline in admissions of AMI, CHF and CI during the first phase of high incidence of COVID-19 and “hard” lockdown measures and expand these towards full chronological assessment [ 24 , 25 , 26 , 27 , 28 , 29 ]. The literature suggests that the initial decline in admissions was associated with the fear of getting infected during hospitalization and being confronted with overloaded care structures [ 24 , 25 , 27 ]. Although the second lockdown lasted more than three times as long as the first one and the number of in-patient COVID-19 patients of Marburg University Hospital clearly surpassed the levels of the first “hard” lockdown, the reactive decline in in-patient cardiovascular cases remained visibly lower.…”

“…Beyond that, the care situation reverted to the pre-pandemic level with the initiation of the national vaccination program in early 2021. Therefore, it could be argued that fear of hospitalization during the first lockdown and other externalities, which led to the reported decline in acute cardiovascular admissions, diminished over the course of the pandemic [ 24 , 25 , 27 ]. The chronological assessment does not provide reference to the discovery of new COVID-19 virus variants having a visible effect on the care situation.…”

Viral infections in cardiometabolic risk and disease between old acquaintances and new enemies

“…One possible explanation for this outcome is that the pandemic may have generated fear and adverse psychological consequences in AMI patients, delaying hospital access [263]. Hence, there was a significant delay in the elapsed time "from symptom onset to first medical contact" when considering "total ischemic time" (definition denoting the elapsed time from the onset of chest pain to the first medical contact, arrival at the hospital, and balloon inflation during primary percutaneous coronary intervention) [263,264]. This behavior denotes patients' hesitation to contact healthcare personnel and go to the hospital or even not seek care at all, which is also confirmed by the higher levels of emotional and symptomatic fear expressions [fear of COVID-19 scale (FCV-19S) questionnaire] found in AMI patients during the pandemic compared to the general population [265,266].…”

“…This behavior denotes patients' hesitation to contact healthcare personnel and go to the hospital or even not seek care at all, which is also confirmed by the higher levels of emotional and symptomatic fear expressions [fear of COVID-19 scale (FCV-19S) questionnaire] found in AMI patients during the pandemic compared to the general population [265,266]. Noteworthy, "door-to-hospital-arrival-time" and "hospital-arrival-toinsufflation-time" did not differ significantly during the pandemic with respect to the pre-COVID period, suggesting an effective organization of the healthcare system and leaving a major role to the patient's fear and reluctance [263,264]. Moreover, health workers, potentially exposed to the pathogen and subjected to high workload and job stress, generally did not receive mental health assistance during the pandemic (e.g., mindfulness-based stress reduction courses to reduce distress during emergency periods), and this may indirectly affect care quality [267].…”