Health professionals report decrease in STEMI admissions since COVID-19 outbreak
A survey conducted by the ESC among cardiologists and CV nurses revealed that 78.8% of responders perceived a decrease in STEMI admissions since the beginning of the COVID-19 outbreak.
Admission of patients with STEMI since the outbreak of the COVID-19 pandemic. A survey by the European Society of CardiologyLiterature - Pessoa-Amorim G, Camm CF, Gajendragadkar P et al., - Eur Heart J Qual Care Clin Outcomes. 2020. doi: 10.1093/ehjqcco/qcaa046.
Introduction and methods
Estimates suggest that over a third of the global population was under some form of “lockdown” by April 2020, due to the COVID-19 pandemic [1]. Reductions in hospital admissions for acute non-communicable conditions, such as myocardial infarction and stroke, have been reported around the same time in several countries [2-9].
CVD remains the primary cause of death worldwide. Globally, 17.9 million people die of CVD every year. 85% Of those deaths are due to heart attach and stroke and ~38% occur below the age of 70 [10-12]. Global healthcare delivery and policy are currently focused on the COVID-19 pandemic. However, other serious conditions, such as acute coronary syndromes (ACS), continue to exist. This survey, conducted by the ESC, probed the perception of cardiologists and CV nurses with regards to the change in frequency and timing of ST-elevation myocardial infarction (STEMI) admissions in their hospital.
An electronic questionnaire was sent to 186,000 ESC contacts. Responders were asked to self-report an estimate of changes in STEMI admissions or delayed presentations and give information about the presence of “lockdown”, extend of COVID-19 related cardiology service restructuring, and number of COVID-19 admissions in their hospital. In total, 3101 individuals responded to the questionnaire (1.7%). 58% Were from Europe, 23.7% from Asia, 7.1% from South America, 5.3% from North America, 4.7% from Afrika and 1.2% from Oceania.
Main results
- 88.3% Of responders reported that their country was in “total lockdown” and 7.1% in “partial lockdown”. 13.3% Reported total restructuring of the cardiology wards, units or departments, 54.9% reported partial restructuring, and 31.8% no change.
- 78.8% Of responders reported that they perceived a decrease in STEMI admissions since the COVID-19 outbreak. Of those who reported a reduction, 65.2% reported that the reduction was >40%.
- 62.2% Reported that STEMI patients were admitted later than usual since the beginning of the COVID-19 outbreak. 58.5% Reported that >40% of STEMI patients presented beyond the optimal window for PCI or thrombolysis.
- 3.0% Of responders perceived an increase in STEMI admissions since the beginning of the COVID-19 outbreak.
- Multivariable analysis showed that responders that reported STEMI admissions outside of the optimal reperfusion window were more likely to be from a country in total lockdown and working in a hospital with >100 COVID related admissions and with total restructured cardiology services, compared to responders who did not report late STEMI admissions.
Conclusion
This survey among cardiologists and CV nurses revealed that 78.8% of responders perceived a decrease in STEMI admissions since the beginning of the COVID-19 outbreak, of which 65.2% reported a reduction of >40%. Only 3.0% of responders reported an increase in STEMI admissions. Responders also reported an increase in STEMI patients who were admitted beyond the optimal window for PCI or thrombolysis.
References
1. World Economic Forum. Nearly 3 billion people around the globe under COVID-19 lockdown - Today's coronavirus updates https://www.weforum.org/agenda/2020/03/todays-coronavirus-updates/
2. Garcia S, Albaghdadi MS, Meraj PM, Schmidt C, Garberich R, Jaffer FA, Dixon S, Rade JJ, Tannenbaum M, Chambers J, Huang PP, Henry TD. Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States during COVID-19 Pandemic. Journal of the American College of Cardiology 2020:27259.
3. Rodriguez-Leor O, Cid-Alvarez B, Ojeda F, Martín-Moreiras J, Rumoroso JR, López-Palop R, Serrador A, Cequier Á, Romaguera R, Cruz I, Pérez de Prado A, Moreno R. Impact of the COVID-19 pandemic on interventional cardiology activity in Spain. REC Interv Cardiol 2020;2:82-89.
4. Metzler B, Siostrzonek P, Binder RK, Bauer A, Reinstadler SJ. Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. Eur Heart J 2020;41(19):1852-1853.
5. De Filippo O, D’Ascenzo F, Angelini F, Bocchino PP, Conrotto F, Saglietto A, Secco GG, Campo G, Gallone G, Verardi R, Gaido L, Iannaccone M, Galvani M, Ugo F, Barbero U, Infantino V, Olivotti L, Mennuni M, Gili S, Infusino F, Vercellino M, Zucchetti O, Casella G, Giammaria M, Boccuzzi G, Tolomeo P, Doronzo B, Senatore G, Grosso Marra W, Rognoni A, Trabattoni D, Franchin L, Borin A, Bruno F, Galluzzo A, Gambino A, Nicolino A, Truffa Giachet A, Sardella G,
Fedele F, Monticone S, Montefusco A, Omedè P, Pennone M, Patti G, Mancone M, De Ferrari
GM. Reduced Rate of Hospital Admissions for ACS during Covid-19 Outbreak in Northern Italy.
New England Journal of Medicine 2020.
6. De Rosa S, Spaccarotella C, Basso C, Calabro MP, Curcio A, Filardi PP, Mancone M, Mercuro G, Muscoli S, Nodari S, Pedrinelli R, Sinagra G, Indolfi C. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. Eur Heart J 2020.
7. Morelli N, Rota E, Terracciano C, Immovilli P, Spallazzi M, Colombi D, Zaino D, Michieletti E, Guidetti D. The Baffling Case of Ischemic Stroke Disappearance from the Casualty Department in the COVID-19 Era. Eur Neurol 2020:1-3.
8. Zhao J, Li H, Kung D, Fisher M, Shen Y, Liu R. Impact of the COVID-19 Epidemic on Stroke Care and Potential Solutions. Stroke;0(0):STROKEAHA.120.030225.
9. Solomon MD, McNulty EJ, Rana JS, Leong TK, Lee C, Sung S-H, Ambrosy AP, Sidney S, Go AS. The Covid-19 Pandemic and the Incidence of Acute Myocardial Infarction. New Engl J Med 2020 DOI: 10.1056/NEJMc2015630.
10. Atlas Writing G, Esc Atlas of Cardiology is a compendium of cardiovascular statistics compiled by the European Heart Agency adotESoC, Developed in collaboration with the national societies of the European Society of Cardiology member c, Timmis A, Townsend N, Gale CP, Torbica A, Lettino M, Petersen SE, Mossialos EA, Maggioni AP, Kazakiewicz D, May HT, De Smedt D, Flather M, Zuhlke L, Beltrame JF, Huculeci R, Tavazzi L, Hindricks G, Bax J, Casadei B, Achenbach S, Wright L, Vardas P. European Society of Cardiology: Cardiovascular Disease Statistics 2019 (Executive Summary). Eur Heart J Qual Care Clin Outcomes 2020;6(1):7-9.
11. Collaborators GBDCoD. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392(10159):1736-1788.
12. World Health Organization. WHO Cardiovascular Disease Factsheet. https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases; 2020 May