The impact of the COVID-19 pandemic on acute coronary syndrome admissions to a tertiary care hospital in Portugal

Calvao, J; Amador, Ana Filipa; Costa, C; Araújo, Paulo; Pinho, Teresa; Freitas, João; Amorim, Sandra; Macedo, Filipe

doi:10.1016/j.repc.2021.01.007

Cited by 13 publications

(14 citation statements)

References 21 publications

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“…Prior studies have found similar trends in HF, acute coronary syndromes and OOHCA. 18 , 6 , 19 , 20 One of the differences in our study, compared to these studies, was a delayed increase in OOHCA and STEMI. It is possible that the increase in OOHCA and STEMI in these other studies could have been directly due to COVID-19.…”

Section: Discussioncontrasting

confidence: 73%

Cardiovascular Outcomes in Nova Scotia During the Early Phase of the COVID-19 Pandemic

et al. 2022

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Background This study sought to determine the impact of the pandemic response to healthcare delivery on outcomes in patients with cardiovascular disease. Methods This is a population-based cohort study performed in the province of Nova Scotia (population 979,499), between Pre-COVID (March 1, 2017 – March 16, 2020) and in-COVID (March 17, 2020 – December 31, 2020) periods. Adult patients (≥18 years) with new onset or existing cardiovascular disease were included for comparison between periods. The main outcome measures included: cardiovascular emergency department visits or hospitalizations, mortality, and out-of-hospital cardiac arrest. Results In the first month of the in-COVID period, emergency department visits (n=51,750) for cardiac symptoms decreased by 20.8% (95% CI 14.0% - 27.0%, p<0.001). Cardiovascular hospitalizations (n=20 609) declined by 48.1% (95% CI 40.4% to 54.9%, p<0.001). In-hospital mortality rate increased in patients with cardiovascular admissions in secondary care institutions by 55.1% (95%CI 10.1%-118%, p=0.013). A decline of 20.4% - 44.0% occurred in cardiovascular surgical/interventional procedures. Out-of-hospital cardiac arrests (n=5528) increased from a monthly mean of 115±15 to 136±14, beginning in May, 2020. Mortality for ambulatory patients awaiting cardiac intervention (n=14,083) increased from 0.16% (n=12501) to 2.49% (n=361) in the in-COVID period (p<0.0001). Conclusion This study demonstrates increased cardiovascular morbidity and mortality during restrictions maintained during COVID-19, in an area with low burden of COVID-19 disease. As the healthcare system recovers or enters subsequent waves of COVID-19, these findings should inform communication to the public regarding cardiovascular symptoms and policy for delivery of cardiovascular care.

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Section: Discussioncontrasting

confidence: 73%

Cardiovascular Outcomes in Nova Scotia During the Early Phase of the COVID-19 Pandemic

et al. 2022

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“…25 Prognosis, in-hospital mortality and in-hospital complications were more prevalent in the pandemic group, but without statistically significant differences. Other authors reported similar findings, 17,25,27 which suggest that Portugal's public health measures were able to maintain primary care services for ACS patients. Even so, some authors from Portuguese healthcare institutions presented different results, with a higher incidence of mechanical ACS complications and in-hospital mortality.…”

Section: Discussionmentioning

confidence: 53%

“…The demographic characteristics of patients were similar and coronary artery disease had the same severity between the two periods, which is in agreement with previous reports from various Portuguese regions. 24,27 Nonetheless, without mortality data from the non-SARS-CoV-2 patients, we still do not know if there was a real reduction in ACS incidence or just a reduction of ACS admissions secondary to decreased demand for medical assistance.…”

Section: Discussionmentioning

confidence: 99%

“…28 This was not the case in Portugal since no differences in reperfusion strategies were found in the national database or other national series. 24,25,27 Also, no differences were reported concerning the clinical presentation and management of the ACS between the two periods.…”

Section: Discussionmentioning

confidence: 99%

“…Our results demonstrated the absence of delays regarding all times to medical assistance and reperfusion in the pandemic context, which is in line with several series of Portuguese healthcare institutions, although a trend towards a delay during the pandemic was observed. 24,25,27 Other countries reported different outcomes, given some countries were able to maintain the times from the onset of symptoms until reperfusion 29,30 while others presented a delay. 22 Therefore, in Portugal, the overall provision of medical assistance and reperfusion did not seem to have been influenced by the SARS-CoV-2 pandemic, probably because the Portuguese healthcare system did not collapse 31 during the first wave of the pandemic.…”

Section: Discussionmentioning

confidence: 99%

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The National Response to Patients with Acute Coronary Syndrome during the First Wave of the COVID-19 Pandemic in Portugal

Santos

Santos²,

Paula³

et al. 2022

Acta Med Port

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Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to changes in healthcare institutions and medical assistance. Non-SARS-CoV-2 related diseases were indirectly affected by the pandemic. Nonetheless, their treatment remains crucial. Cardiovascular conditions such as acute coronary syndrome (ACS) are common, and it was necessary to adjust medical assistance to these diseases during the pandemic. This study aimed to assess the national impact and healthcare system response during the first wave of the pandemic in patients admitted for ACS.Material and Methods: Multicenter retrospective study based on the Acute Coronary Syndrome Portuguese National Registry between the 1st January 2016 and the 28th February 2021. Two groups were defined: the previous year to the SARS-CoV-2 pandemic (March, April, May and June 2019) (952 patients) and the first wave of the pandemic (March, April, May and June 2020) (642 patients). Clinical course, time until reperfusion, in-hospital outcomes and follow-up at one year were compared between both periods.Results: There was a lower incidence of ACS between March and June 2020 compared with the same period in 2019, with a reduction of 32.6%. There were no statistically significant differences between the two periods regarding patient demographic characteristics (except for a higher prevalence of familiar cardi vascular history and chronic obstructive pulmonary disease in 2020 and higher prevalence of diabetes in 2019), clinical features, clinical management, in-hospital major adverse cardiac events, mortality and readmission at one-year follow-up. There was a trend towards longer delays until reperfusion, yet without statistical significance. The patients that developed ACS during the first wave of the SARS-CoV-2 pandemic were less often referred to percutaneous coronary intervention centers (p = 0.034) and were more frequently transferred to another hospital (p < 0.001).Conclusion: During the first wave of the SARS-CoV-2 pandemic there was a nationwide reduction in demand of healthcare services due to ACS events. Even though the Portuguese healthcare system was under strain and forced to divert resources and medical assistance towards the pandemic management, it was capable of responding adequately to ACS.

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Investigating the implications of COVID-19 outbreak on systems of care and outcomes of STEMI patients: A systematic review and meta-analysis

Kamarullah¹,

Sabrina²,

Rocky³

et al. 2021

Indian Heart Journal

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Introduction There has been a concern whether the decrease in ST-segment elevation myocardial infarction (STEMI) cases during the COVID-19 pandemic era is related to unsatisfactory performance of STEMI systems of care as well as worsening of the clinical outcomes in STEMI patients. Thus, our meta-analysis was conducted to evaluate this matter. Methods We compared the predetermined variables in this meta-analysis during the early and late pandemic. Using a combination of adapted search terms to fit the requirements of several search engines (PubMed, EuropePMC, SCOPUS, ProQuest, and EBSCOhost), we reviewed all observational studies citing our outcomes of interest before and during the outbreak. Results Thirty-five records comprising a total of 62,247 participants were identified. Overall, our meta-analysis showed that there was a huge reduction of nearly 80% for STEMI admission during the outbreak ( n = 10,263) in contrast to before the outbreak period ( n = 51,984). STEMI patients who were admitted during the outbreak received less primary PCI and had longer symptom-to-FMC (first medical contact) time along with prolonged door-to-balloon (DTB) time. A decrease in the achievement of final TIMI (thrombolysis in myocardial infarction) 3 flow after primary PCI was also observed in this study. However, the number of in-hospital mortality was similar between two groups. Conclusion There was a decrease in the STEMI care performance and worsening of clinical outcomes in STEMI patients, especially in the early pandemic period. Overall, concise health services must be implemented following a responsibility to obey health protocols to deliver high-quality services related to STEMI systems of care amidst the global pandemic.

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The impact of the COVID-19 pandemic on acute coronary syndrome admissions to a tertiary care hospital in Portugal

Cited by 13 publications

References 21 publications

Cardiovascular Outcomes in Nova Scotia During the Early Phase of the COVID-19 Pandemic

Cardiovascular Outcomes in Nova Scotia During the Early Phase of the COVID-19 Pandemic

The National Response to Patients with Acute Coronary Syndrome during the First Wave of the COVID-19 Pandemic in Portugal

Investigating the implications of COVID-19 outbreak on systems of care and outcomes of STEMI patients: A systematic review and meta-analysis

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