Emergency medical services evaluations for chest pain during first COVID-19 lockdown in Hollands-Midden, the Netherlands

Abstract

Objective To assess whether the COVID-19 lockdown in 2020 had negative indirect health effects, as people seem to have been reluctant to seek medical care. Methods All emergency medical services (EMS) transports for chest pain or out-of-hospital cardiac arrest (OHCA) in the Dutch region Hollands-Midden (population served > 800,000) were evaluated during the initial 6 weeks of the COVID-19 lockdown and during the same time period in 2019. The primary endpoint was the number of evaluated chest pain patients in both cohorts. In addition, the number of EMS evaluations of ST-elevation myocardial infarction (STEMI) and OHCA were assessed. Results During the COVID-19 lockdown period, the EMS evaluated 927 chest pain patients (49% male, age 62 ± 17 years) compared with 1041 patients (51% male, 63 ± 17 years) in the same period in 2019, which corresponded with a significant relative risk (RR) reduction of 0.88 (95% confidence interval (CI) 0.81–0.96). Similarly, there was a significant reduction in the number of STEMI patients (RR 0.52, 95% CI 0.32–0.85), the incidence of OHCA remained unchanged (RR 1.23, 95% CI 0.83–1.83). Conclusion During the first COVID-19 lockdown, there was a significant reduction in the number of patients with chest pain or STEMI evaluated by the EMS, while the incidence of OHCA remained similar. Although the reason for the decrease in chest pain and STEMI consultations is not entirely clear, more attention should be paid to the importance of contacting the EMS in case of suspected cardiac symptoms in possible future lockdowns.

Impact of the COVID-19 pandemic on the epidemiology of out-of-hospital cardiac arrest: a systematic review and meta-analysis

“…Ten studies reported or provided sufficient data to calculate the annual OHCA incidence (per 100,000 population) (Additional file 1 : Table S2) [ 6 – 8 , 26 , 31 , 32 , 35 – 37 , 39 ]. Among them, de Koning et al [ 35 ] reported the lowest annual OHCA incidence of 51 and 63 cases per 100,000 population in the pre-COVID-19 and COVID-19 time periods, respectively.…”

“…Ten studies reported or provided sufficient data to calculate the annual OHCA incidence (per 100,000 population) (Additional file 1 : Table S2) [ 6 – 8 , 26 , 31 , 32 , 35 – 37 , 39 ]. Among them, de Koning et al [ 35 ] reported the lowest annual OHCA incidence of 51 and 63 cases per 100,000 population in the pre-COVID-19 and COVID-19 time periods, respectively. Meanwhile, Glober et al [ 36 ] reported the highest annual OHCA incidence of 183 and 214 cases per 100,000 population in the pre-COVID-19 and COVID-19 time periods, respectively.…”

Impact of the COVID-19 pandemic on the epidemiology of out-of-hospital cardiac arrest: A systematic review and meta-analysis

“…Fifteen studies provided data for the characteristic of shockable rhythm. [6][7][8][23][24][25]27,28,[31][32][33]35,36,38,39 The percentage who had shockable rhythm ranged from 3.6-40% across intervals of the pre-COVID-19 and COVID-19 time periods. Apart from Semeraro et al 31 , all studies reported a trend of lower percentage with shockable rhythm in the COVID-19 period as compared to the pre-COVID-19 period.…”

“…* EMS, Emergency Medical Services; † UK, United Kingdom; ‡ USA, United States of America; § NR, Not Reported; || COVID-19, coronavirus disease 2019; # Study designs for all included studies were multicentred and retrospective in nature * EMS, Emergency Medical Services; † UK, United Kingdom; ‡ USA, United States of America; § NR, Not Reported; || COVID-19, coronavirus disease 2019; # Study designs for all included studies were multicentred and retrospective in nature * EMS, Emergency Medical Services; † UK, United Kingdom; ‡ USA, United States of America; § NR, Not Reported; || COVID-19, coronavirus disease 2019; # Study designs for all included studies were multicentred and retrospective in nature * EMS, Emergency Medical Services; † UK, United Kingdom; ‡ USA, United States of America; § NR, Not Reported; || COVID-19, coronavirus disease 2019; # Study designs for all included studies were multicentred and retrospective in nature * ROSC, Return of Spontaneous Circulation; † CI, Con dence Interval; ‡ OR, Odds Ratio; § N/A, Not Applicable; || OHCA, Out-of-Hospital Cardiac Arrest; # P values were obtained from two-proportions ztests comparing Pre-COVID-19 and COVID-19 pooled valuesAll studies achieved a score ranging from 7 to 9 on the Newcastle-Ottawa Scale, signifying high quality and low risk of bias for selection (Supplemental Table1).3.2.1 Primary Outcomes: Annual OHCA IncidenceTen studies reported or provided su cient data to calculate the annual OHCA incidence (per 100000 population) (Supplemental Table2).6-8, 24,29,30, 33-35,37 Among them, de Koning et al33 reported the lowest annual OHCA incidence of 51 and 63 cases per 100000 population in the pre-COVID-19 and COVID-19 time periods respectively. Meanwhile, Glober et al 34 reported the highest annual OHCA incidence of 183 and 214 cases per 100000 population in the pre-COVID-19 and COVID-19 time periods respectively.…”

Out-of-hospital cardiac arrest and COVID-19 pandemic

“…Overall survival was also lower, primarily in communities with moderate or high COVID-19 mortality [11]. Contrary to most of the publications in the Netherlands during the first COVID-19 lockdown, the incidence of OHCA remained on the sable level, while there was a significant reduction in the number of patients with chest pain or STEMI [12]. A Spanish Nationwide Prospective Cohort Study showed that during the COVID-19 period, the incidence of resuscitation attempts declined and survival to hospital admission (OR = 1.72; 95%CI = 1.46-2.04; p < 0.001) and discharge (OR = 1.38; 95%CI = 1.07-1.78; p = 0.013) fell compared to the non-COVID period.…”