Quality of acute myocardial infarction care in England and Wales during the COVID-19 pandemic: linked nationwide cohort study

Abstract

Background and objectiveThe impact of the COVID-19 pandemic on the quality of care for patients with acute myocardial infarction (AMI) is uncertain. We aimed to compare quality of AMI care in England and Wales during and before the COVID-19 pandemic using the 2020 European Society of Cardiology Association for Acute Cardiovascular Care quality indicators (QIs) for AMI.MethodsCohort study of linked data from the AMI and the percutaneous coronary intervention registries in England and Wales between 1 January 2017 and 27 May 2020 (representing 236 743 patients from 186 hospitals). At the patient level, the likelihood of attainment for each QI compared with pre COVID-19 was calculated using logistic regression. The date of the first national lockdown in England and Wales (23 March 2020) was chosen for time series comparisons.ResultsThere were 10 749 admissions with AMI after 23 March 2020. Compared with before the lockdown, patients admitted with AMI during the first wave had similar age (mean 68.0 vs 69.0 years), with no major differences in baseline characteristics (history of diabetes (25% vs 26%), renal failure (6.4% vs 6.9%), heart failure (5.8% vs 6.4%) and previous myocardial infarction (22.9% vs 23.7%)), and less frequently had high Global Registry of Acute Coronary Events risk scores (43.6% vs 48.6%). There was an improvement in attainment for 10 (62.5%) of the 16 measured QIs including a composite QI (43.8% to 45.2%, OR 1.06, 95% CI 1.02 to 1.10) during, compared with before, the lockdown.ConclusionDuring the first wave of the COVID-19 pandemic in England and Wales, quality of care for AMI as measured against international standards did not worsen, but improved modestly.

Impact of COVID-19 on Hospital Admissions and Healthcare Quality Indicators in Non-COVID Patients: A Retrospective Study of the First COVID-19 Year in a University Hospital in Spain

“…As reported in other contexts, the reduction in admissions for nervous system diseases was accompanied by a marked drop in activations of stroke codes, and consequently, the number of recanalisation treatments (rtPA and thrombectomy) was greatly reduced during the pandemic [ 26 , 27 ]. In line with some studies [ 28 ], but contrasting with others [ 10 ], this study did not find higher in-hospital mortality for these conditions despite the greater severity of admitted patients, highlighting the maintenance of quality standards during the pandemic. Nevertheless, the drop in hospitalizations coincides with an increase in out-of-hospital cardiac arrest events [ 29 , 30 ] and greater mortality from cardiovascular diseases during the COVID period [ 4 , 31 , 32 ] observed in Spain and other countries.…”

“…The comparison of the main healthcare quality indicators between the COVID and pre-COVID periods revealed an overall increase in the complication rate but not in-hospital mortality rates. This information provides an overview of the impact of the pandemic on the quality of care for non-COVID diseases, thus far only shown specifically by some diseases [ 27 , 28 ]. The rise in complication rates may be explained by a mixture of changes in internal processes, high staff turnover, including among resident physicians, and healthcare reorganisation, which can be added to the effect of attending to patients with more severe diseases and greater management difficulties.…”

Effects of healthcare system transformations spurred by the COVID-19 pandemic on management of stroke and STEMI: a registry-based cohort study in France

“…Prior studies investigating the association between the COVID-19 pandemic and the quality of stroke and STEMI management reported diverse results 13–16. Our data suggest that these discordant results are a result of the variety of policies implemented and the heterogeneity of hospital organisations.…”

“…Prior studies investigating the association between the COVID-19 pandemic and the quality of stroke and STEMI management reported diverse results. [13][14][15][16] Our data suggest that these discordant results are a result of the variety of policies implemented and the heterogeneity of hospital organisations. To our knowledge, no study has analysed at a regional level the effect of reorganisations implemented by hospitals to deal with the COVID-19 pandemic.…”

“…12 However, results on the effect of the COVID-19 pandemic on the intrahospital quality of care of these two diseases are diverse. [13][14][15][16] We hypothesised that this may be due to the organisational environment of hospitals and the timing and type of reorganisations implemented to cope with the COVID-19 pandemic. Beyond national directives, each hospital had authority over its reorganisation, according to local capacity.…”