Impact of the COVID-19 Pandemic on Patients Without COVID-19 With Acute Myocardial Infarction and Heart Failure.
Daniel K FoxR J WakenDaniel Y JohnsonGmerice HammondJonathan YuErika FanousThomas M MaddoxKaren E Joynt MaddoxPublished in: Journal of the American Heart Association (2022)
Background Excess mortality from cardiovascular disease during the COVID-19 pandemic has been reported. The mechanism is unclear but may include delay or deferral of care, or differential treatment during hospitalization because of strains on hospital capacity. Methods and Results We used emergency department and inpatient data from a 12-hospital health system to examine changes in volume, patient age and comorbidities, treatment (right- and left-heart catheterization), and outcomes for patients with acute myocardial infarction (AMI) and heart failure (HF) during the COVID-19 pandemic compared with pre-COVID-19 (2018 and 2019), controlling for seasonal variation. We analyzed 27 427 emergency department visits or hospitalizations. Patient volume decreased during COVID-19 for both HF and AMI, but age, race, sex, and medical comorbidities were similar before and during COVID-19 for both groups. Acuity increased for AMI as measured by the proportion of patients with ST-segment elevation. There were no differences in right-heart catheterization for patients with HF or in left heart catheterization for patients with AMI. In-hospital mortality increased for AMI during COVID-19 (odds ratio [OR], 1.46; 95% CI, 1.21-1.76), particularly among the ST-segment-elevation myocardial infarction subgroup (OR, 2.57; 95% CI, 2.24-2.96), but was unchanged for HF (OR, 1.02; 95% CI, 0.89-1.16). Conclusions Cardiovascular volume decreased during COVID-19. Despite similar patient age and comorbidities and in-hospital treatments during COVID-19, mortality increased for patients with AMI but not patients with HF. Given that AMI is a time-sensitive condition, delay or deferral of care rather than changes in hospital care delivery may have led to worse cardiovascular outcomes during COVID-19.
Keyphrases
- acute myocardial infarction
- percutaneous coronary intervention
- heart failure
- healthcare
- st segment elevation myocardial infarction
- emergency department
- acute heart failure
- left ventricular
- palliative care
- adverse drug
- acute care
- atrial fibrillation
- coronavirus disease
- cardiovascular disease
- acute coronary syndrome
- coronary artery disease
- sars cov
- case report
- quality improvement
- cardiovascular events
- end stage renal disease
- ultrasound guided
- cardiac resynchronization therapy
- risk factors
- clinical trial
- escherichia coli
- pain management
- affordable care act
- electronic health record
- combination therapy
- prognostic factors
- adipose tissue
- big data
- insulin resistance
- skeletal muscle
- weight loss
- smoking cessation