07 Aug Hospitalizations for Heart Attacks Drop Sharply During COVID Pandemic
MedicalResearch.com Interview with:
Ty J. Gluckman, M.D., FACC
Providence St Joseph Health
MedicalResearch.com: What is the background for this study?
Response: In spite of significant decreases in the incidence of coronary artery disease, an estimated 800,000 Americans are expected to be diagnosed with an acute myocardial infarction (AMI) this year. For large numbers of these patients, substantial benefit is afforded by early diagnosis and treatment. Accordingly, multiple campaigns have been launched over time to increase public awareness about the symptoms and signs of AMI and the need to seek immediate medical attention.
The COVID-19 pandemic has profoundly changed health care delivery worldwide. While early attention was disproportionately focused on efforts to “flatten the curve”, recent reports have revealed a disturbing finding—a substantial decrease in the hospitalization rate for AMI. Most worrisome among potential reasons for this has been reluctance of patients with an AMI to seek medical attention out of fear that they become infected with SARS-CoV-2.
To better understand the impacts associated with this, we performed a retrospective, cross-sectional study of all AMI hospitalizations in a large multistate health care system (Providence St. Joseph Health). We sought to define changes in AMI case rates, patient demographics, cardiovascular comorbidities, treatment approaches and in-hospital outcomes during the pandemic.
MedicalResearch.com: What are the main findings?
Response: The study analyzed acute myocardial infarction hospitalizations that occurred between December 30, 2018 and May 16, 2020 in 1 of 6 states in the Western US. The cohort included 15,244 AMI hospitalizations involving 14,724 patients. Beginning February 23, 2020, AMI hospitalizations decreased at a rate of -19.0 cases per week for 5 weeks (early COVID-19 period). Thereafter, cases increased at a rate of +10.5 cases per week (later COVID-19 period), but had not returned to baseline by the end of the evaluated period. At its nadir, weekly AMI hospitalizations were down nearly 50%.
While no appreciable differences in patient demographics, cardiovascular comorbidities and treatment approaches were observed across periods, patients hospitalized during the COVID-19 period were 1-3 years younger, had a shorter length of stay, and were more likely to be discharged to home. In addition, notable differences in risk-adjusted mortality were observed over the periods analyzed. Patients hospitalized during the COVID-19 period had a higher risk-adjusted mortality rate, that was disproportionately noted in patients with ST-segment elevation myocardial infarction (STEMI). This risk increased in a step-wise fashion, with the highest rate in the later COVID-19 period.
MedicalResearch.com: What should readers take away from your report?
Response: Our cross-sectional study found important changes in acute myocardial infarction hospitalization rates that appear to validate previous concerns that large numbers of patients with AMI initially avoided hospitalization during the COVID-19 pandemic. While hospitalization rates for AMI have begun to increase, so too has the risk of in-hospital mortality, particularly among those with STEMI.
Given the time-sensitive nature of STEMI, any delay by patients, emergency medical services, the emergency department or cardiac catheterization laboratory may have major consequences. Accordingly, any patient with symptoms or signs of a heart attack should be encouraged to seek immediate medical attention. Because the timing of a vaccine is currently unknown, our study also reinforces the need to address important care processes for patients with AMI to help mitigate further risk.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Further research is needed to identify factors associated with the higher observed mortality rate, particularly among those with STEMI.
MedicalResearch.com: Is there anything else you would like to add?
Response: This study adds to the growing body of literature that has noted adverse outcomes among non-communicable diseases during the pandemic. It also reinforces that while social distancing with COVID-19 is recommended, medical distancing is not. (#StopMedicalDistancing)
None of the authors have any disclosures.
Gluckman TJ, Wilson MA, Chiu S, et al. Case Rates, Treatment Approaches, and Outcomes in Acute Myocardial Infarction During the Coronavirus Disease 2019 Pandemic. JAMA Cardiol. Published online August 07, 2020. doi:10.1001/jamacardio.2020.3629
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