Delay in seeking medical help by STEMI patients during the COVID-19 outbreak

Introduction and methods

The potential negative impact of a community outbreak of infectious disease like the COVID-19 pandemic on proper health care of STEMI patients is not understood.

The present study evaluated the impact of the COVID-19 outbreak on STEMI care in a single center in Hong Kong during the COVID-19 outbreak, from January 25, 2020, when hospitals in Hong Kong started to institute emergency infection protocols to contain COVID-19, until February 10, 2020. Included were patients (n=7) with PPCI-treated STEMI and who did not suffer from a COVID-19 infection. 6 Patients presented during office hours and 1 during non-office hours. STEMI care was compared to treatment of STEMI patients treated with PPCI in the prior year (from February 1, 2018 until January 31, 2019) (n=108), before the COVID-19 outbreak.

Outcome measures were defined as times from (1) patient-reported chest discomfort onset to first medical contact, (2) patient arrival at the Accident and Emergency Department to successful wire crossing during PPCI and (3) patient arrival at the catheterization laboratory to successful wire crossing.

Main results

• For patients treated during the COVID-19 outbreak, time of symptom onset to first medical contact was delayed (318 min [IQR: 75-458]. Before the outbreak, this time was 82.5 [32.5-195] for patients presented during office hours (n=48) and 91.5 [35.25-232.75] for patients presented during non-office hours (n=60).

• For patients treated during the COVID-19 outbreak, time of arrival at the department to device was delayed as compared to patients treated before the COVID-19 outbreak, but only if the latter group was treated during office hours (during outbreak, time was 110 min [93-142]; before outbreak, time was 84.5 [65.25-109.75] during office hours and time was 129 [106–159] during non-office hours).

• For patients treated during the COVID-19 outbreak, time of arrival at the catherization laboratory to device was delayed (during outbreak, time was 33 min [21-37]; before outbreak, time was 20.5 [16-27.75] during office hours and time was 24 [18-30] during non-office hours).

Conclusion

In a hospital in Hong Kong, there were delays in seeking medical help by 7 STEMI patients, most visible in the time from symptom onset to first medical contact, after institution of infection control measures due to the COVID-19 outbreak, as compared to STEMI care of similar patients before the outbreak. In addition, due to the COVID-19 outbreak, time from patient arrival at the emergency department to successful wire crossing during PPCI, as well as time from patient arrival at the catheterization laboratory to successful wire crossing, were also delayed. This study shows how public health emergencies such as the COVID-19 outbreak can have an indirect effect on healthcare in unrelated areas.

Find this article online at Circ Cardiovasc Qual Outcomes