Hospital admissions for acute myocardial infarction before and after lockdown according to regional prevalence of COVID-19 and patient profile in France: a registry study

Abstract

Background The COVID-19 pandemic has had a profound effect on general health care. We aimed to evaluate the effect of a nationwide lockdown in France on admissions to hospital for acute myocardial infarction, by patient characteristics and regional prevalence of the pandemic. Methods In this registry study, we collected data from 21 centres participating in the ongoing French Cohort of Myocardial Infarction Evaluation (FRENCHIE) registry, which collects data from all patients admitted for ST segment elevation myocardial infarction (STEMI) or non-ST segment elevation myocardial infarction (NSTEMI) within 48 h of symptom onset. We analysed weekly hospital admissions over 8 weeks: the 4 weeks preceding the institution of the lockdown and the 4 weeks following lockdown. The primary outcome was the change in the number of hospital admissions for all types of acute myocardial infarction, NSTEMI, and STEMI between the 4 weeks before lockdown and the 4 weeks after lockdown. Comparisons between categorical variables were made using χ² tests or Fisher's exact tests. Comparisons of continuous variables were made using Student's t tests or Mann-Whitney tests. Poisson regression was used to determine the significance of change in hospital admissions over the two periods, after verifying the absence of overdispersion. Age category, region, and type of acute myocardial infarction (STEMI or NSTEMI) were used as covariables. The FRENCHIE cohort is registered with ClinicalTrials.gov, NCT04050956. Findings Between Feb 17 and April 12, 2020, 1167 patients were consecutively admitted within 48 h of acute myocardial infarction (583 with STEMI, 584 with NSTEMI) and were included in the study. Admissions for acute myocardial infarction decreased between the periods before and after lockdown was instituted, from 686 before to 481 after lockdown (30% decrease; incidence rate ratio 0⋅69 [95% CI 0⋅51-0⋅70]). Admissions for STEMI decreased from 331 to 252 (24%; 0⋅72 [0⋅62-0⋅85]), and admissions for NSTEMI decreased from 355 to 229 (35%; 0⋅64 [0⋅55-0⋅76]) following institution of the lockdown, with similar trends according to sex, risk factors, and regional prevalence of hospital admissions for COVID-19. Interpretation A marked decrease in hospital admissions was observed following the lockdown, irrespective of patient characteristics and regional prevalence of COVID-19. Health authorities should be aware of these findings, in order to adapt their message if the COVID-19 pandemic persists or recurs, or in case of future major epidemics. Funding Recherche Hospitalo-Universitaire en Santé iVasc.

Cardiac arrhythmias in hospitalized patients with COVID-19: A prospective observational study in the western United States

“…Consistently with the previous studies, elevated troponin levels were associated with mortality in our patient population. There is a possibility that the patients with coronary artery disease might have avoided seeing a doctor or coming to a hospital although they developed cardiac symptoms, due to the concerns of exposure to COVID-19 [13]. Such patients might have come to hospital eventually when they contracted COVID-19 and this could have led to high levels of troponin and high mortality.…”

Effect of the COVID-19 pandemic on mortality of patients with STEMI: a systematic review and meta-analysis

“…Our metaanalysis is also in line with the results of a recently published large multicentre registry study, who observed a significant decline in STEMI admissions during lockdown in France, with unchanged times from symptom onset to FMC, and increases in in-hospital delays, but no significant difference in in-hospital deaths. 30 Nevertheless, it remains possible that the observational period is still too short to detect a significant difference in mortality. As a consequence, prospective studies comprising a longer follow-up period are necessary to further comment on this issue.…”

COVID-19 pandemic: complex interactions with the arrhythmic profile and the clinical course of patients with cardiovascular disease

“…This decline is accelerated by acute events related to multiple triggers and modulating factors, and can be influenced, in terms of delay or acceleration, in a way that is currently unpredictable as a consequence of COVID-19 and associated lockdown. Some manifestations of CVD, such as acute myocardial infarction (MI), both ST elevation MI and non-ST elevation MI, 16 as well as new-onset or worsening heart failure, 17 were actually reduced during COVID-19. On the other hand, an increase in out-of-hospital cardiac arrests (OHCAs) was reported, associated with reduced survival, with cases of confirmed or suspected COVID-19 accounting for only one-third of the increase in OHCA incidence during the pandemic.…”