Admission of patients with STEMI since the outbreak of the COVID-19 pandemic: a survey by the European Society of Cardiology

Abstract

Aims The COVID-19 pandemic required a significant redeployment of worldwide healthcare resources. Fear of infection, national lockdowns and altered healthcare priorities have the potential to impact utilisation of healthcare resources for non-communicable diseases. To survey health professionals’ views of the impact of the COVID-19 pandemic on the rate and timing of admission of patients with ST-elevation myocardial infarction (STEMI), the European Society of Cardiology (ESC) administered an internet-based questionnaire to cardiologists and cardiovascular nurses across 6 continents. Methods and results 3101 responses were received from 141 countries across 6 continents. 88.3% responded that their country was in “total lockdown” and 7.1% in partial lockdown. 78.8% responded that the number of patients presenting with STEMI was reduced since the coronavirus outbreak and 65.2% indicated that the reduction in STEMI presentations was >40%. Approximately 60% of all respondents reported that STEMI patients presented later than usual and 58.5% that >40% of STEMI patients admitted to hospital presented beyond the optimal window for primary percutaneous intervention (PCI) or thrombolysis. Independent predictors of the reported higher rate of delayed STEMI presentation were a country in total lockdown, >100 COVID-19 cases admitted locally, and the complete restructuring of the local cardiology service. Conclusion The survey indicates that the impact of COVID-19 on STEMI presentations is likely to be substantial, with both lower presentations and a higher rate of delayed presentations occurring. This has potentially important ramifications for future healthcare and policy planning in the event of further waves of this pandemic.

COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives

“… 74 ). This observation is in accordance with the finding that the number of patients with myocardial infarction seeking urgent hospital care declined by >50% during the peak of the COVID-19 outbreak, as reported in an extensive global survey by the ESC 75 .…”

COVID-19 pandemic and STEMI: pathway activation and outcomes from the pan-London heart attack group

“…Finally, those patients who did seek help may not have been prioritised by the ambulance service who were under immense pressure at the time and a proportion of these patients may have deteriorated and died before receiving medical attention. In addition to the fall in acute presentations, survey data suggest a corresponding increase in the incidence of cardiac related complications associated with untreated STEMI 21 ; however, the long-term implications remain unclear.…”

Community and healthcare system-related factors feeding the phenomenon of evading medical attention for time-dependent emergencies during COVID-19 crisis

“…Anecdotal evidence suggests that the principal reason behind this is patient's anxiety to avoid seeking medical care at hospitals and overwhelmed healthcare systems due to the pandemic. 1 Patients are less inclined to visit hospitals with fear of acquiring COVID-19. Many patients with risk factors of STEMI may dismiss their angina symptoms as benign relative to this fear.…”