COVID-19 and changes in activity and treatment of ST elevation MI from a UK cardiac centre.
COVID-19
Indirect morbidity and mortality
STEMI
Thrombolysis
Journal
International journal of cardiology. Heart & vasculature
ISSN: 2352-9067
Titre abrégé: Int J Cardiol Heart Vasc
Pays: Ireland
ID NLM: 101649525
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
03
07
2020
revised:
29
01
2021
accepted:
03
02
2021
entrez:
1
3
2021
pubmed:
2
3
2021
medline:
2
3
2021
Statut:
ppublish
Résumé
The international healthcare response to COVID-19 has been driven by epidemiological data related to case numbers and case fatality rate. Second order effects have been less well studied. This study aimed to characterise the changes in emergency activity of a high-volume cardiac catheterisation centre and to cautiously model any excess indirect morbidity and mortality. Retrospective cohort study of patients admitted with acute coronary syndrome fulfilling criteria for the heart attack centre (HAC) pathway at St. Bartholomew's hospital, UK. Electronic data were collected for the study period March 16th - May 16th 2020 inclusive and stored on a dedicated research server. Standard governance procedures were observed in line with the British Cardiovascular Intervention Society audit. There was a 28% fall in the number of primary percutaneous coronary interventions (PCIs) for ST elevation myocardial infarction (STEMI) during the study period (111 vs. 154) and 36% fewer activations of the HAC pathway (312 vs. 485), compared to the same time period averaged across three preceding years. In the context of 'missing STEMIs', the excess harm attributable to COVID-19 could result in an absolute increase of 1.3% in mortality, 1.9% in nonfatal MI and 4.5% in recurrent ischemia. The emergency activity of a high-volume PCI centre was significantly reduced for STEMI during the peak of the first wave of COVID-19. Our data can be used as an exemplar to help future modelling within cardiovascular workstreams to refine aggregate estimates of the impact of COVID-19 and inform targeted policy action.
Sections du résumé
BACKGROUND
BACKGROUND
The international healthcare response to COVID-19 has been driven by epidemiological data related to case numbers and case fatality rate. Second order effects have been less well studied. This study aimed to characterise the changes in emergency activity of a high-volume cardiac catheterisation centre and to cautiously model any excess indirect morbidity and mortality.
METHOD
METHODS
Retrospective cohort study of patients admitted with acute coronary syndrome fulfilling criteria for the heart attack centre (HAC) pathway at St. Bartholomew's hospital, UK. Electronic data were collected for the study period March 16th - May 16th 2020 inclusive and stored on a dedicated research server. Standard governance procedures were observed in line with the British Cardiovascular Intervention Society audit.
RESULTS
RESULTS
There was a 28% fall in the number of primary percutaneous coronary interventions (PCIs) for ST elevation myocardial infarction (STEMI) during the study period (111 vs. 154) and 36% fewer activations of the HAC pathway (312 vs. 485), compared to the same time period averaged across three preceding years. In the context of 'missing STEMIs', the excess harm attributable to COVID-19 could result in an absolute increase of 1.3% in mortality, 1.9% in nonfatal MI and 4.5% in recurrent ischemia.
CONCLUSIONS
CONCLUSIONS
The emergency activity of a high-volume PCI centre was significantly reduced for STEMI during the peak of the first wave of COVID-19. Our data can be used as an exemplar to help future modelling within cardiovascular workstreams to refine aggregate estimates of the impact of COVID-19 and inform targeted policy action.
Identifiants
pubmed: 33644297
doi: 10.1016/j.ijcha.2021.100736
pii: S2352-9067(21)00024-5
pmc: PMC7901371
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100736Informations de copyright
© 2021 Published by Elsevier B.V.
Références
Lancet. 2003 Jan 4;361(9351):13-20
pubmed: 12517460
Eur Heart J Qual Care Clin Outcomes. 2020 Jul 1;6(3):210-216
pubmed: 32467968
J Am Coll Cardiol. 2020 Sep 15;76(11):1375-1384
pubmed: 32330544
Circulation. 2018 Nov 13;138(20):e618-e651
pubmed: 30571511
Heart. 2020 Dec;106(23):1805-1811
pubmed: 32868280
Heart. 2011 Aug;97(16):1293-7
pubmed: 21719554
J Am Coll Cardiol. 2020 Sep 8;76(10):1168-1176
pubmed: 32679155
Eur Heart J. 2020 Jun 7;41(22):2083-2088
pubmed: 32412631
Lancet. 1994 Feb 5;343(8893):311-22
pubmed: 7905143
Am Heart J. 2020 Aug;226:45-48
pubmed: 32497914
Clin Med (Lond). 2020 Sep;20(5):e170-e172
pubmed: 32719037
J Am Heart Assoc. 2020 Nov 17;9(22):e018379
pubmed: 33023348
J Clin Epidemiol. 2008 Apr;61(4):344-9
pubmed: 18313558
Eur Heart J Qual Care Clin Outcomes. 2020 Jul 30;:
pubmed: 32730620
Lancet. 2020 May 30;395(10238):1715-1725
pubmed: 32405103