Impact of COVID-19 outbreak on regional STEMI care in Germany

Abstract

Aims To assess the impact of the lockdown due to coronavirus disease 2019 (COVID-19) on key quality indicators for the treatment of ST-segment elevation myocardial infarction (STEMI) patients. Methods Data were obtained from 41 hospitals participating in the prospective Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) study, including 15,800 patients treated for acute STEMI from January 2017 to the end of March 2020. Results There was a 12.6% decrease in the total number of STEMI patients treated at the peak of the pandemic in March 2020 as compared to the mean number treated in the March months of the preceding years. This was accompanied by a significant difference among the modes of admission to hospitals ( p = 0.017) with a particular decline in intra-hospital infarctions and transfer patients from other hospitals, while the proportion of patients transported by emergency medical service (EMS) remained stable. In EMS-transported patients, predefined quality indicators, such as percentages of pre-hospital ECGs (both 97%, 95% CI = − 2.2–2.7, p = 0.846), direct transports from the scene to the catheterization laboratory bypassing the emergency department (68% vs. 66%, 95% CI = − 4.9–7.9, p = 0.641), and contact-to-balloon-times of less than or equal to 90 min (58.3% vs. 57.8%, 95%CI = − 6.2–7.2, p = 0.879) were not significantly altered during the COVID-19 crisis, as was in-hospital mortality (9.2% vs. 8.5%, 95% CI = − 3.2–4.5, p = 0.739). Conclusions Clinically important indicators for STEMI management were unaffected at the peak of COVID-19, suggesting that the pre-existing logistic structure in the regional STEMI networks preserved high-quality standards even when challenged by a threatening pandemic. Clinical trial registration NCT00794001 Electronic supplementary material The online version of this article (10.1007/s00392-020-01703-z) contains supplementary material, which is available to authorized users.

Reduced rate of admissions for acute coronary syndromes during the COVID-19 pandemic: an observational analysis from a tertiary hospital in Germany

“…In the case of ST-elevation myocardial infarction (STEMI) with suspected COVID-19, the protocol dictates immediate cardiac catheterization in a dedicated catheter laboratory with all protective measures in place, including proper negative pressure room ventilation and personal protective devices such as FFP‑3 face masks, in accordance with guidelines of the German Society of Cardiology [ 13 ]. With regard to door-to-balloon intervals, a possible delay in care delivery has been observed in the current literature [ 5 ], while other studies showed no significant delay in ACS management throughout the STEMI Network in Germany, and as the authorsʼ managing protocols did not change during the outbreak, they do not expect a significant delay to have taken place in their hospital [ 2 ].…”

“…[13]. With regard to door-to-balloon intervals, a possible delay in care delivery has been observed in the current literature [5], while other studies showed no significant delay in ACS management throughout the STEMI Network in Germany, and as the authors' managing protocols did not change during the outbreak, they do not expect a significant delay to have taken place in their hospital [2].…”

“…A relevant part of the healthcare system has also been redirected in management of COVID-19 cases. As a result of this and as a measure to avoid in-hospital contagion, elective non-urgent procedures and hospital admissions were drastically reduced and postponed in all medical specialties, while the management of urgent cases proceeded unchanged [ 2 ]. However, recent publications show that urgent and potentially life-saving procedures and admissions have also been inadvertently reduced, the reasons for such troublesome findings being likely multifactorial and not yet studied in depth [ 3 – 8 ].…”

Complications and mortality of cardiovascular emergency admissions during COVID-19 associated restrictive measures

“…Instead, secondary effects that are not directly related to COVID-19 disease such as misinterpretation of symptoms (dyspnea and chest discomfort rather interpreted as sign of respiratory disease by the patient), strict instructions to stay at home, and increased fear of patients to contact SARS-CoV-2 in medical facilities as a consequence of RM and of the impact of the pandemic situation on individual decision making may be responsible for delayed contact with health care professionals. Of note, the authors of an analysis of the FITT-STEMI trial reported that pre-clinical logistic structures, including contact-to-ballon times, were preserved during the COVID-19 pandemic in Germany, supporting the concept that delayed admissions may indeed result from hesitation to contact the medical system [ 23 ]. Avoiding health care may similarly be the reason for less new diagnoses of cancer in the Netherlands since the onset of the COVID-19 pandemic, thereby likely delaying timely therapeutic intervention and also impairing prognosis [ 24 ].…”

“…hesitation to contact the medical system [23]. Avoiding health care may similarly be the reason for less new diagnoses of cancer in the Netherlands since the onset of the COVID-19 pandemic, thereby likely delaying timely therapeutic intervention and also impairing prognosis [24].…”