Changes in the investigation and management of suspected myocardial infarction and injury during COVID-19: a multi-centre study using routinely collected healthcare data
Changes in the investigation and management of suspected myocardial infarction and injury during COVID-19: a multi-centre study using routinely collected healthcare data
Objective: the COVID-19 pandemic was associated with a reduction in the incidence of myocardial infarction (MI) diagnosis, in part because patients were less likely to present to hospital. Whether changes in clinical decision making with respect to the investigation and management of patients with suspected MI also contributed to this phenomenon is unknown.
Methods: multicentre retrospective cohort study in three UK centres contributing data to the National Institute for Health Research Health Informatics Collaborative. Patients presenting to the Emergency Department (ED) of these centres between 1st January 2020 and 1st September 2020 were included. Three time epochs within this period were defined based on the course of the first wave of the COVID-19 pandemic: pre-pandemic (epoch 1), lockdown (epoch 2), post-lockdown (epoch 3).
Results: during the study period, 10,670 unique patients attended the ED with chest pain or dyspnoea, of whom 6,928 were admitted. Despite fewer total ED attendances in epoch 2, patient presentations with dyspnoea were increased (p < 0.001), with greater likelihood of troponin testing in both chest pain (p = 0.001) and dyspnoea (p < 0.001). There was a dramatic reduction in elective and emergency cardiac procedures (both p < 0.001), and greater overall mortality of patients (p < 0.001), compared to the pre-pandemic period. Positive COVID-19 and/or troponin test results were associated with increased mortality (p < 0.001), though the temporal risk profile differed.
Conclusions: the first wave of the COVID-19 pandemic was associated with significant changes not just in presentation, but also the investigation, management, and outcomes of patients presenting with suspected myocardial injury or MI.
Chammas, Lara
b1a35710-9950-4af1-a96e-e1941b6a5cb9
Yuan, Kevin
2b6374be-f38e-4808-b820-3610311e1d2a
Little, Stephanie
95d53062-a495-4b2f-a970-c11122789b61
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Chammas, Lara
b1a35710-9950-4af1-a96e-e1941b6a5cb9
Yuan, Kevin
2b6374be-f38e-4808-b820-3610311e1d2a
Little, Stephanie
95d53062-a495-4b2f-a970-c11122789b61
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Chammas, Lara, Yuan, Kevin and Little, Stephanie
,
et al.
(2024)
Changes in the investigation and management of suspected myocardial infarction and injury during COVID-19: a multi-centre study using routinely collected healthcare data.
Frontiers in Cardiovascular Medicine, 11, [1406608].
(doi:10.3389/fcvm.2024.1406608).
Abstract
Objective: the COVID-19 pandemic was associated with a reduction in the incidence of myocardial infarction (MI) diagnosis, in part because patients were less likely to present to hospital. Whether changes in clinical decision making with respect to the investigation and management of patients with suspected MI also contributed to this phenomenon is unknown.
Methods: multicentre retrospective cohort study in three UK centres contributing data to the National Institute for Health Research Health Informatics Collaborative. Patients presenting to the Emergency Department (ED) of these centres between 1st January 2020 and 1st September 2020 were included. Three time epochs within this period were defined based on the course of the first wave of the COVID-19 pandemic: pre-pandemic (epoch 1), lockdown (epoch 2), post-lockdown (epoch 3).
Results: during the study period, 10,670 unique patients attended the ED with chest pain or dyspnoea, of whom 6,928 were admitted. Despite fewer total ED attendances in epoch 2, patient presentations with dyspnoea were increased (p < 0.001), with greater likelihood of troponin testing in both chest pain (p = 0.001) and dyspnoea (p < 0.001). There was a dramatic reduction in elective and emergency cardiac procedures (both p < 0.001), and greater overall mortality of patients (p < 0.001), compared to the pre-pandemic period. Positive COVID-19 and/or troponin test results were associated with increased mortality (p < 0.001), though the temporal risk profile differed.
Conclusions: the first wave of the COVID-19 pandemic was associated with significant changes not just in presentation, but also the investigation, management, and outcomes of patients presenting with suspected myocardial injury or MI.
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2024_04_29_altered_investigation_management
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fcvm-11-1406608
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Accepted/In Press date: 2 May 2024
e-pub ahead of print date: 21 May 2024
Identifiers
Local EPrints ID: 492657
URI: http://eprints.soton.ac.uk/id/eprint/492657
ISSN: 2297-055X
PURE UUID: 5cd4360c-3379-4d58-8999-f98018cbc565
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Date deposited: 09 Aug 2024 16:46
Last modified: 15 Aug 2024 01:39
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Author:
Lara Chammas
Author:
Kevin Yuan
Author:
Stephanie Little
Corporate Author: et al.
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