COVID-19 Pandemic and Acute Coronary Syndrome Admission Rates

Quick Takes

  • The average weekly number of ACS admissions fell by 40% during the pandemic compared with the average weekly number observed during 2019 in England.
  • Patients who do not go to the hospital with an ACS, especially STEMI, are deprived of the benefit from reperfusion therapy or other appropriate treatments and are at increased risk of complications.
  • It is imperative to urgently address the public's fear that they might contract COVID-19 by going to the hospital to prevent unnecessary morbidity and mortality from ACS.

Study Questions:

What is the scale, nature, and duration of changes to admissions for different types of acute coronary syndrome (ACS), and impact of in-hospital management of patients as a result of the coronavirus disease 2019 (COVID-19) pandemic in England?

Methods:

The investigators analyzed data on hospital admissions in England for types of ACS from January 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), MI of unknown type, or other ACS (including unstable angina). The authors identified revascularization procedures undertaken during these admissions (i.e., coronary angiography without percutaneous coronary intervention [PCI], PCI, and coronary artery bypass grafting). They calculated the numbers of weekly admissions and procedures undertaken; percentage reductions in weekly admissions and across subgroups were also calculated, with 95% confidence intervals (CIs).

Results:

Hospital admissions for ACS declined from mid-February 2020, falling from a 2019 baseline rate of 3,017 admissions per week to 1,813 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 2,522 admissions, representing a 16% (95% CI, 13–20) reduction from baseline. During the period of declining admissions, there were reductions in the number of admissions for all types of ACS, including both STEMI and NSTEMI, but relative and absolute reductions were larger for NSTEMI, with 1,267 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 ACS fell from 4 days (interquartile range, 2–9) in 2019 to 3 days (1–5) by the end of March 2020.

Conclusions:

The authors concluded that there was a substantial reduction in the weekly number of patients with ACS who were admitted to the hospital during the pandemic, which had been partly reversed by the end of May 2020.

Perspective:

This study reports that by the end of March 2020, the average weekly number of ACS admissions fell by 40% compared with the average weekly number during 2019. Overall, from January 2020, until the end of May 2020, there had been approximately 8,000 fewer admissions for ACS than would be expected, including 5,000 fewer admissions for MI. Patients who do not go to the hospital with an ACS, especially STEMI, are deprived of the benefit from reperfusion therapy or other appropriate treatments and are at increased risk of complications. It is imperative to address the public's fear that they might contract COVID-19 by going to the hospital to prevent unnecessary morbidity and mortality from ACS. The American College of Cardiology, through its CardioSmart patient initiative, has issued guidance to patients having a heart attack or stroke to call 911, reassuring individuals that hospitals have safety measures to protect them from COVID-19 infection.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Acute Coronary Syndrome, Angina, Unstable, Coronary Angiography, Coronary Artery Bypass, Coronavirus, COVID-19, Length of Stay, Myocardial Infarction, Myocardial Reperfusion, Myocardial Revascularization, Percutaneous Coronary Intervention, Secondary Prevention, severe acute respiratory syndrome coronavirus 2, ST Elevation Myocardial Infarction


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