Impact of the COVID-19 outbreak on hospitalizations and outcomes in patients with acute myocardial infarction in a Japanese Single Center

Arai, Riku; Fukamachi, Daisuke; Ebuchi, Yasunari; Migita, Suguru; Morikawa, Tomoyuki; Monden, Masaki; Takei, Norio; Tamaki, Takehiro; Kojima, Kensuke; Akutsu, Naotaka; Murata, Nobuhiro; Kitano, Daisuke; Okumura, Yasuo

doi:10.1007/s00380-021-01835-w

Cited by 16 publications

(15 citation statements)

References 26 publications

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“…While the previous study did not suggest a significant difference in the onset-to-door time [median (control period vs. COVID-19 period): 205 vs. 266 minutes, p=0.20] ( 9 ), our study revealed a significantly longer time during the COVID-19 period (128 vs. 241 minutes, p=0.028). Regarding the prognosis, while the 30-day cumulative mortality rates were comparable in the previous study (8.3% vs. 9.4%, p=0.772, log-rank test), they were found to be higher during the COVID-19 pandemic in the present study (6.6% vs. 13.7%, p=0.074, log-rank test).…”

Section: Discussioncontrasting

confidence: 99%

“…In Japan, limited studies have reported the time course and STEMI outcomes during the early COVID-19 pandemic. A single-center retrospective cohort study from Tokyo showed no significant differences in the time course or 30-day mortality in STEMI patients before and after the COVID-19 outbreak ( 9 ), while another study from Osaka reported that the in-hospital mortality was comparable, despite an increased incidence of late presentation and mechanical complications of STEMI ( 10 ). In contrast, we demonstrated treatment delays and a tendency toward increased STEMI mortality during this pandemic; however, the increment in mortality was not significant.…”

Section: Discussionmentioning

confidence: 99%

“…In Japan, few studies have reported the impact of the COVID-19 pandemic and state of emergency on STEMI patients. A previous study from Tokyo revealed that the time course of STEMI management and mortality was comparable before and after the pandemic ( 9 ). Another study from Osaka reported similar mortality rates before and after the pandemic, despite an increased incidence of mechanical complications of STEMI ( 10 ).…”

Section: Introductionmentioning

confidence: 98%

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Impact of the COVID-19 Pandemic on ST-elevation Myocardial Infarction from a Single-center Experience in Tokyo

et al. 2021

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Objective The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on global healthcare systems. Some studies have reported the negative impact of COVID-19 on ST-elevation myocardial infarction (STEMI) patients; however, the impact in Japan remains unclear. This study investigated the impact of the COVID-19 pandemic on STEMI patients admitted to an academic tertiary-care center in Tokyo, Japan. Methods In this retrospective, observational, cohort study, we included 398 consecutive patients who were admitted to our institute from January 1, 2018, to March 10, 2021, and compared the incidence of hospitalization, clinical characteristics, time course, management, and outcomes before and after March 11, 2020, the date when the World Health Organization declared COVID-19 a pandemic. Results There was a 10.7% reduction in hospitalization of STEMI patients during the COVID-19 pandemic compared with that in the previous year (117 vs. 131 cases). During the COVID-19 pandemic, the incidence of late presentation was significantly higher (26.5% vs. 12.1%, p<0.001), and the onset-to-door (241 ] min, p=0.028) and door-to-balloon (72 [IQR: 61-128] vs. 60 [IQR: 43-90] min, p<0.001) times were significantly longer than in the previous year. Furthermore, the in-hospital mortality was higher, but the difference was not significant (9.4% vs. 5.0%, p=0.098). Conclusions The COVID-19 pandemic significantly impacted STEMI patients in Tokyo and resulted in a slight decrease in hospitalization, a significant increase in late presentation and treatment delays, and a slight but nonsignificant increase in mortality. In the COVID-19 era, the acute management system for STEMI in Japan must be reviewed.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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Impact of the COVID-19 Pandemic on ST-elevation Myocardial Infarction from a Single-center Experience in Tokyo

et al. 2021

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“…Similarly, tertiary centres have reported a decline in the number of patients presenting with myocardial infarction during the pandemic, particularly those with no-ST segment elevation myocardial infarction [ 20 ], with studies demonstrating longer times from symptom onset to presentation [ 21 ] and of patients declining hospital admission [ 22 ]. Given that further pandemic-related lockdowns are a possibility going forward, it is imperative that we deliver the message to older people that deferring medical assessment and care when unwell is unsafe and generally not in their best interests, particularly in the case of complaints such as chest pain or acute neurological symptoms.…”

Section: Discussionmentioning

confidence: 99%

Trends in emergency department use by older people during the COVID-19 pandemic

et al. 2021

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Purpose Reports suggest that many older people deferred seeking healthcare during the COVID-19 pandemic due to fear of contracting COVID-19. The aim of this study was to examine trends of emergency department (ED) use by older people during the first wave of the COVID-19 pandemic compared to previous years. Methods The study site is a 1000-bed university teaching hospital with annual ED new-patient attendance of > 50,000. All ED presentations of patients aged ≥ 70 years from March to August 2020, 2019 and 2018 inclusive (n = 13,989) were reviewed and compared for presenting complaint, Manchester Triage Score, and admission/discharge decision. Results There was a 16% reduction in presentations across the 6 months in 2020 compared to the average of 2018/2019. On average, 4 fewer people aged ≥ 70 years presented to the ED per day in 2020. Much of this was concentrated in March (33% fewer presentations) and April (31% fewer presentations), when the country was in ‘lockdown’, i.e. non-essential journeys were banned. There was a 20% reduction in patients presenting with stroke and cardiac complaints. In the 3 months following easing of restrictions, there was a 25% increase in falls and orthopaedic injuries when compared to 2018/2019. Conclusion This study demonstrates a significant decline in the number of older people presenting to the ED for unscheduled care, including for potentially time-dependent illnesses such as stroke or cardiac complaints. Given the possibility of further lockdowns, it is imperative that we consider enabling strategies to ensure older people access unscheduled care in a timely manner when necessary.

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“…Additionally, 56 records were excluded based on several reasons: 1) outcomes of interest were not relevant ( n = 31); 2) a comparison between two period was not reported ( n = 16); 3) articles were case report/series ( n = 9). Eventually, a total of 35 studies with 62,247 participants 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 were evaluated in our meta-analysis. STEMI patients who presented in the pandemic period were older, predominately from male population, had a higher prevalence of comorbid conditions, and had worse cardiac function during hospital admission.…”

Section: Resultsmentioning

confidence: 99%

Investigating the implications of COVID-19 outbreak on systems of care and outcomes of STEMI patients: A systematic review and meta-analysis

Kamarullah¹,

Sabrina²,

Rocky³

et al. 2021

Indian Heart Journal

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Introduction There has been a concern whether the decrease in ST-segment elevation myocardial infarction (STEMI) cases during the COVID-19 pandemic era is related to unsatisfactory performance of STEMI systems of care as well as worsening of the clinical outcomes in STEMI patients. Thus, our meta-analysis was conducted to evaluate this matter. Methods We compared the predetermined variables in this meta-analysis during the early and late pandemic. Using a combination of adapted search terms to fit the requirements of several search engines (PubMed, EuropePMC, SCOPUS, ProQuest, and EBSCOhost), we reviewed all observational studies citing our outcomes of interest before and during the outbreak. Results Thirty-five records comprising a total of 62,247 participants were identified. Overall, our meta-analysis showed that there was a huge reduction of nearly 80% for STEMI admission during the outbreak ( n = 10,263) in contrast to before the outbreak period ( n = 51,984). STEMI patients who were admitted during the outbreak received less primary PCI and had longer symptom-to-FMC (first medical contact) time along with prolonged door-to-balloon (DTB) time. A decrease in the achievement of final TIMI (thrombolysis in myocardial infarction) 3 flow after primary PCI was also observed in this study. However, the number of in-hospital mortality was similar between two groups. Conclusion There was a decrease in the STEMI care performance and worsening of clinical outcomes in STEMI patients, especially in the early pandemic period. Overall, concise health services must be implemented following a responsibility to obey health protocols to deliver high-quality services related to STEMI systems of care amidst the global pandemic.

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Impact of the COVID-19 outbreak on hospitalizations and outcomes in patients with acute myocardial infarction in a Japanese Single Center

Cited by 16 publications

References 26 publications

Impact of the COVID-19 Pandemic on ST-elevation Myocardial Infarction from a Single-center Experience in Tokyo

Impact of the COVID-19 Pandemic on ST-elevation Myocardial Infarction from a Single-center Experience in Tokyo

Trends in emergency department use by older people during the COVID-19 pandemic

Investigating the implications of COVID-19 outbreak on systems of care and outcomes of STEMI patients: A systematic review and meta-analysis

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