Open Access
COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England
Marion Mafham,Enti Spata,Enti Spata,Raphael Goldacre,Dominic Gair,Paula Curnow,Mark Bray,Sam Hollings,Chris Roebuck,Chris Gale,Mamas A. Mamas,John E. Deanfield,Mark A de Belder,Thomas F Luescher,Tom Denwood,Martin J Landray,Martin J Landray,Jonathan Emberson,Jonathan Emberson,Rory Collins,Eva Morris,Barbara Casadei,Colin Baigent,Colin Baigent +23 more
TLDR
The reduced number of admissions during this period is likely to have resulted in increases in out-of-hospital deaths and long-term complications of myocardial infarction and missed opportunities to offer secondary prevention treatment for patients with coronary heart disease.Abstract:
BACKGROUND: Several countries affected by the COVID-19 pandemic have reported a substantial drop in the number of patients attending the emergency department with acute coronary syndromes and a reduced number of cardiac procedures. We aimed to understand the scale, nature, and duration of changes to admissions for different types of acute coronary syndrome in England and to evaluate whether in-hospital management of patients has been affected as a result of the COVID-19 pandemic. METHODS: We analysed data on hospital admissions in England for types of acute coronary syndrome from Jan 1, 2019, to May 24, 2020, that were recorded in the Secondary Uses Service Admitted Patient Care database. Admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), myocardial infarction of unknown type, or other acute coronary syndromes (including unstable angina). We identified revascularisation procedures undertaken during these admissions (ie, coronary angiography without percutaneous coronary intervention [PCI], PCI, and coronary artery bypass graft surgery). We calculated the numbers of weekly admissions and procedures undertaken; percentage reductions in weekly admissions and across subgroups were also calculated, with 95% CIs. FINDINGS: Hospital admissions for acute coronary syndrome declined from mid-February, 2020, falling from a 2019 baseline rate of 3017 admissions per week to 1813 per week by the end of March, 2020, a reduction of 40% (95% CI 37-43). This decline was partly reversed during April and May, 2020, such that by the last week of May, 2020, there were 2522 admissions, representing a 16% (95% CI 13-20) reduction from baseline. During the period of declining admissions, there were reductions in the numbers of admissions for all types of acute coronary syndrome, including both STEMI and NSTEMI, but relative and absolute reductions were larger for NSTEMI, with 1267 admissions per week in 2019 and 733 per week by the end of March, 2020, a percent reduction of 42% (95% CI 38-46). In parallel, reductions were recorded in the number of PCI procedures for patients with both STEMI (438 PCI procedures per week in 2019 vs 346 by the end of March, 2020; percent reduction 21%, 95% CI 12-29) and NSTEMI (383 PCI procedures per week in 2019 vs 240 by the end of March, 2020; percent reduction 37%, 29-45). The median length of stay among patients with acute coronary syndrome fell from 4 days (IQR 2-9) in 2019 to 3 days (1-5) by the end of March, 2020. INTERPRETATION: Compared with the weekly average in 2019, there was a substantial reduction in the weekly numbers of patients with acute coronary syndrome who were admitted to hospital in England by the end of March, 2020, which had been partly reversed by the end of May, 2020. The reduced number of admissions during this period is likely to have resulted in increases in out-of-hospital deaths and long-term complications of myocardial infarction and missed opportunities to offer secondary prevention treatment for patients with coronary heart disease. The full extent of the effect of COVID-19 on the management of patients with acute coronary syndrome will continue to be assessed by updating these analyses. FUNDING: UK Medical Research Council, British Heart Foundation, Public Health England, Health Data Research UK, and the National Institute for Health Research Oxford Biomedical Research Centre.read more
Citations
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COVID-19 and resilience of healthcare systems in ten countries
Catherine Arsenault,Anna D. Gage,Min Kyung Kim,Neena R Kapoor,Patricia Akweongo,Fred Amponsah,Amit Aryal,Daisuke Asai,John Koku Awoonor-Williams,Wondimu Ayele,Paula Bedregal,Svetlana V. Doubova,Mahesh Dulal,Dominic Dormenyo Gadeka,Georgiana Gordon-Strachan,Damen Haile Mariam,Dilipkumar Hensman,Jean Paul Joseph,Phanuwich Kaewkamjornchai,Munir K. Eshetu,Solomon Gelaw,Shogo Kubota,Borwornsom Leerapan,Paula Margozzini,Anagaw Mebratie,Suresh Mehata,Mosa Moshabela,Londiwe Yvonne Mthethwa,Adiam Nega,Juhwan Oh,S. Park,A. Passi-Solar,Ricardo Pérez-Cuevas,Alongkhone Phengsavanh,Tarylee Reddy,Thanitsara Rittiphairoj,Jaime Sapag,Roody Thermidor,Boikhutso Tlou,Francisco Valenzuela Guiñez,Sebastian Bauhoff,Margaret E Kruk +41 more
TL;DR: In this article , the authors used an interrupted time series design to assess the immediate effect of the Coronavirus Disease 2019 (COVID-19) pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People's Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income countries.
Journal ArticleDOI
The worldwide impact of telemedicine during COVID-19: current evidence and recommendations for the future
Stefano Omboni,Raj Padwal,Tourkiah Alessa,Béla Benczúr,Beverly B. Green,Ilona Hubbard,Kazuomi Kario,Nadia A. Khan,Alexandra Konradi,Alexander G. Logan,Yuan Lu,Maurice Mars,Richard J McManus,Sarah Melville,C. L. Neumann,Gianfranco Parati,Nicolas Federico Renna,Philippe Ryvlin,Hugo Saner,Aletta E. Schutte,Ji-Guang Wang +20 more
TL;DR: If all requirements to enable large scale implementation of telemedicine are met in the near future, remote management of patients will become an indispensable resource for the healthcare systems worldwide and will ultimately improve themanagement of patients and the quality of care.
Journal ArticleDOI
Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales
R. Knight,Venexia M Walker,Samantha Ip,Jonathan A. Cooper,Thomas Bolton,Spencer Keene,Rachel Denholm,Ashley Akbari,Hoda Abbasizanjani,Fatemeh Torabi,E. Omigie,Sam Hollings,Teri-Louise North,Renin Toms,Xi-Yuan Jiang,Emanuele Di Angelantonio,Spiros Denaxas,Johan H. Thygesen,Christopher Tomlinson,Benoît De Bray,Craig Smith,Mark Barber,Kamlesh Khunti,George Davey Smith,Nish Chaturvedi,Cathie Sudlow,William Whiteley,Angela M. Wood,Jonathan A C Sterne +28 more
TL;DR: High relative incidence of vascular events soon after COVID-19 diagnosis declines more rapidly for arterial thromboses than VTEs, however, incidence remains elevated up to 49 weeks after COIDs19 diagnosis.
Journal ArticleDOI
Cardiovascular disease and mortality sequelae of COVID-19 in the UK Biobank
Zahra Raisi-Estabragh,Jackie A. Cooper,A. Salih,Betty Raman,Aaron M. Lee,Stefan Neubauer,Nicholas C. Harvey,Steffen E. Petersen +7 more
TL;DR: Individuals hospitalised with COVID-19 have increased risk of incident cardiovascular events across a range of disease and mortality outcomes, and the risk of most events is highest in the early postinfection period.
Journal ArticleDOI
The collateral damage of COVID-19 to cardiovascular services: a meta-analysis
Ramesh Nadarajah,Jian-Hen Wu,Ben Hurdus,Samira Asma,Deepak L. Bhatt,Giuseppe Biondi-Zoccai,Laxmi S. Mehta,C Venkata S Ram,Antonio Luiz Pinho Ribeiro,Harriette G.C. Van Spall,John E. Deanfield,Thomas F. Lüscher,Mamas A. Mamas,Chris P Gale +13 more
TL;DR: There was substantial global collateral CV damage during the COVID-19 pandemic with disparity in severity by country income classification.
References
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Christian Spaulding,Luc-Marie Joly,Alain Rosenberg,Mehran Monchi,Simon Weber,Jean-François Dhainaut,Pierre Carli +6 more
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TL;DR: During the Covid-19 outbreak in northern Italy, the daily rate of admissions for acute coronary syndrome at 15 hospitals was significantly lower than in previous outbreaks.
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