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      Patient response, treatments and mortality for acute myocardial infarction during the COVID-19 pandemic

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          Abstract

          Aim

          COVID-19 might have affected the care and outcomes of hospitalised acute myocardial infarction (AMI). We aimed to determine whether the COVID-19 pandemic changed patient response, hospital treatment and mortality from AMI.

          Methods and Results

          Admission were classified as non ST-elevation myocardial infarction (NSTEMI) or STEMI at 99 hospitals in England through live feeding from the Myocardial Ischaemia National Audit Project between 1 st January, 2019 and 22 nd May, 2020. Time series plots were estimated using a 7-day simple moving average, adjusted for seasonality. From 23 rd March, 2020 (UK lockdown) median daily hospitalisations decreased more for NSTEMI (69 to 35; IRR 0.51, 95% CI 0.47-0.54) than STEMI (35 to 25; IRR 0.74, 95% CI 0.69-0.80) to a nadir on 19th April, 2020. During lockdown, patients were younger (mean age 68.7 years vs. 66.9 years), less frequently diabetic (24.6% vs. 28.1%) or had cerebrovascular disease (7.0% vs. 8.6%). STEMI more frequently received primary PCI (81.8% vs 78.8%%), thrombolysis was negligible (0.5% vs. 0.3%), median admission-to-coronary angiography duration for NSTEMI decreased (26.2 vs. 64.0 hours), median duration of hospitalisation decreased (4 to 2 days), secondary prevention pharmacotherapy prescription remained unchanged (each >94.7%). Mortality at 30 days increased for NSTEMI (from 5.4% to 7.5%; OR 1.41, 95% CI 1.08-1.80), but decreased for STEMI (from 10.2% to 7.7%; OR 0.73, 95% CI 0.54-0.97).

          Conclusions

          During COVID-19, there was a substantial decline in admissions with AMI. Those who presented to hospital were younger, less co-morbid and, for NSTEMI, had higher 30-day mortality.

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          Author and article information

          Journal
          Eur Heart J Qual Care Clin Outcomes
          Eur Heart J Qual Care Clin Outcomes
          ehjqcc
          European Heart Journal. Quality of Care & Clinical Outcomes
          Oxford University Press
          2058-5225
          2058-1742
          30 July 2020
          Affiliations
          [1 ] Leeds Institute for Data Analytics, University of Leeds , Leeds, UK
          [2 ]Division of Clinical and Translational Research, School of Dentistry, University of Leeds , Leeds, UK
          [3 ]Keele Cardiovascular Research Group, Institute for Prognosis Research, University of Keele , Keele, UK
          [4 ] Glangwili General Hospital , Carmarthen, Wales, UK
          [5 ] National Institute for Cardiovascular Outcomes Research , Barts Health NHS Trust, London
          [6 ] Imperial College, National Heart and Lung Institute , London
          [7 ] Institute of Cardiovascular Sciences, University College , London
          [8 ] Leeds Teaching Hospitals NHS Trust , Leeds, UK
          [9 ] Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds , Leeds, UK
          Author notes
          Correspondence: Professor Chris P Gale, Co-Director Leeds Institute for Data Analytics, Leeds Institute of Cardiovascular and Metabolic Medicine, Worsley Building, Level 11, Clarendon Way, University of Leeds, Leeds, LS2 9JT, UK. Email: c.p.gale@ 123456leeds.ac.uk , Tel: 0044 (0)113 343 8916, Twitter: @cpgale3
          Article
          qcaa062
          10.1093/ehjqcco/qcaa062
          7454506
          32730620
          Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions please email: journals.permissions@oup.com.

          This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

          This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

          Page count
          Pages: 23
          Product
          Categories
          Original Article
          AcademicSubjects/MED00200
          Custom metadata
          accepted-manuscript
          PAP

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