Management of Acute Coronary Syndrome in the COVID Era

Background Higher incidence of acute coronary syndrome (ACS), among those with lower income, has been recognized in the most recent decades. Still, there is a paucity of data on temporal changes. This study aims to investigate 20-year time trends in income-related disparity in the incidence of ACS in Denmark. Methods This Population-based repeated cross-sectional study included all patients with first-time ACS, aged ≥20 years, registered in the Danish National Patient Registry 1998–2017. Aggregated sociodemographic data for the Danish population was accessed from Statistics Denmark. Yearly incidence rates (IR) and incidence rate ratios (IRR), with the highest-income quartile as a reference, were standardized using cell-specific personal equivalent income according to year, sex and age group with 95% confidence intervals. Interaction analysis was executed for differences in IR of ACS between the lowest- and highest-income quartile over time. Results A total of 220 070 patients hospitalized with ACS from 1998 to 2017 were identified. The yearly standardized ACS IRs decreased in all income quartiles. However, the IR remained higher in the lowest-income quartile compared to the highest for both men [1998: IRR 1.45 (95% confidence interval, CI 1.39–1.52) and 2017: 1.47 (1.40–1.54)] and women [1998: IRR 1.73 (1.64–1.82) and 2017: 1.76 (1.65–1.88)]. Interaction analysis showed that over the period the difference in IR between the lower- and the highest-income quartile decreased with 1–5 ACS cases per 100 000 person-year. Conclusion Income-related disparity in the incidence of ACS was present in Denmark between 1998 and 2017. Despite a marked overall decrease in the yearly ACS incidence, the extent of income-related disparity remained unchanged.

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“…10 , 24 Hence, the coronavirus 2019 (COVID-19) pandemic has no impact on the ACS hospitalizations in the present study. 29 …”

Section: Methodsmentioning

confidence: 99%

Time trends in income-related disparity in incidence of acute coronary syndrome

Simoni

Kragholm

Bøggild

et al. 2023

European Journal of Public Health

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“…In general, vaccinations against COVID-19 have proven to be effective and safe in COVID-19 prevention, limiting disease severity, hospitalizations and mortality rates [ 51 ], but they also altered the procedures and improved healthcare efficacy.…”

Section: Changes After Vaccine Rolloutmentioning

confidence: 99%

“…This calls for the healthcare system to establish standard operating procedures and policies to ensure proper and efficient care for ACS patients under similar conditions. The advances in telemedicine during the pandemic allowed the quality of the healthcare to be improved [ 51 ].…”

Section: Challenges In the Near Futurementioning

confidence: 99%

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The impact of the coronavirus pandemic on patients hospitalized due to acute coronary syndrome

Jankowska-Sanetra¹,

Sanetra²,

Synak³

et al. 2023

pwki

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The coronavirus disease 2019 (COVID-19) pandemic significantly increased mortality worldwide. However, only part of the excess mortality is related directly to the infection. Local healthcare accessibility, time to reach medical care and patients’ reluctance to seek medical aid strongly affected the treatment results in many fields. The current report aims to analyze mortality and morbidity in patients who suffered from acute coronary syndrome (ACS) during the COVID-19 pandemic, as well as to investigate the factors that may have a significant impact on their baseline characteristics and outcome. Multiple reports were evaluated. Most of them point to reluctance and longer time to reach medical care, longer pre-hospital delay, lower overall number of ACS admissions, greater percentage of ST-elevation myocardial infarction patients and complications. Younger and less ill patients were more likely to suffer from ACS than in the pre-pandemic period. They presented with more prominent biomarker elevation. Further, the number of invasive procedures dropped significantly, which was most prominent in the field of surgical revascularization. Consequently, a higher number of adverse events and greater mortality during the COVID-19 pandemic were noted, which was valid for both patients with and without coronavirus infection. In summary, the pandemic had a great impact on overall populational mortality and morbidity, which was greatly pronounced in patients with cardiovascular disease, particularly in ACS cases. They differed in baseline characteristics, underwent different treatment and their outcome was worse as compared with the period prior to the pandemic.

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“…Medical treatment may include dual antiplatelet medications: aspirin and a P2Y12 inhibitor such as clopidogrel which is considered only when invasive management will be delayed and the patient is not at risk of bleeding; beta-blockers if there are no contraindications; angiotensin-converting enzyme inhibitors/angiotensin receptor blockers; nitrates (except with right ventricular infarction in which decreasing preload may be harmful) and statins. If hypoxia is present, the patient should receive oxygen [ 44 , 45 ].…”

Section: Reviewmentioning

confidence: 99%

COVID-19 and Acute Coronary Syndrome: A Literature Review

Akinrinmade¹,

Obitulata-Ugwu²,

Obijiofor³

et al. 2022

Cureus

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The coronavirus disease 2019, also known as the COVID-19 pandemic has had a deleterious impact on daily living, with health and socioeconomic effects of a global magnitude. Acute coronary syndrome (ACS), an important cardiovascular disease with significant morbidity and mortality rates, has been frequently reported in patients with this novel virus. This review aims to discuss the potential associations between COVID-19 and ACS with the use of multiple databases, including but not limited to; PubMed, ScienceDirect, World Health Organization, and American Heart Association.We have explored the pathophysiology of ACS, focusing on COVID-19 in particular with the use of various works of literature that highlights the pattern of viral entry and replication via the angiotensin-converting enzyme II. The review has also discussed the impact of the pandemic on hospital admissions, diagnosis, and management of ACS patients, as well as briefly highlighted a possible link between the widely available COVID-19 vaccines and possible cardiovascular complications.The association between COVID-19 and ACS needs more in-depth studies to help establish whether there exists a direct causal and or inciting correlation between them. Understanding this association might lead to new research and treatment options for ACS patients.

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Management of Acute Coronary Syndrome in the COVID Era

Cited by 8 publications

References 31 publications

Time trends in income-related disparity in incidence of acute coronary syndrome

Time trends in income-related disparity in incidence of acute coronary syndrome

The impact of the coronavirus pandemic on patients hospitalized due to acute coronary syndrome

COVID-19 and Acute Coronary Syndrome: A Literature Review

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