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COVID-19 and Cardiology Read more

STEMI admissions during COVID-19

An ESC survey on ST-elevation myocardial infarction (STEMI) admissions during the pandemic

Throughout the world, the COVID-19 pandemic has strongly impacted cardiac departments, healthcare professionals and patients. COVID-19 has kept more than half of heart attack patients away from hospitals.

3,101 healthcare practitioners involved in the treatment of STEMI patients in 141 countries completed an online survey from 16 to 26 April 2020.



New findings

"Globally, cardiovascular disease (CVD) remains the primary cause of death claiming the lives of 17.9 million people every year; of these deaths, 85% are due to heart attack and stroke and ~38% are premature (below the age of 70). Whilst global healthcare delivery and policy are currently focused on the COVID-19 pandemic, we must not forget that other serious conditions, such as acute coronary syndromes (ACS) - for which we can deploy life-saving evidence-based treatments - not only continue to exist, but may even increase in prevalence during an infectious disease pandemic.
Here we present the results of a survey conducted by the ESC probing the perception of cardiologists and cardiovascular nurses with regards to ST-elevation myocardial infarction (STEMI) admissions to their hospitals."
 
Authors: Guilherme Pessoa-Amorim, Christian F Camm, Parag Gajendragadkar, Giovanni Luigi De Maria, Celine Arsac, Cecile Laroche, José Luis Zamorano, Franz Weidinger, Stephan Achenbach, Aldo P Maggioni, Chris P Gale, Athena Poppas, Barbara Casadei
 

Press release

“Patients’ fears of becoming infected by going to hospital must be addressed. They need to be assured that the in-hospital risk of coronavirus infection has been minimised for patients being admitted with heart attacks or strokes. If you have chest pain or other heart attack symptoms – such as pain in the throat, neck, back, stomach or shoulders that lasts for more than 15 minutes – you must call an ambulance. Remember that COVID-19 mortality is 10 times lower than that of an untreated heart attack. And rapid treatment for a heart attack works.” Professor Barbara Casadei, ESC President.

“Don’t delay if you have heart attack symptoms: call emergency. Every minute counts.”
Professor Dariusz Dudek, EAPCI President.

Download the press release 

Key findings of the research

The survey revealed that one of the main consequences of the pandemic was that fewer severe heart attack patients went to hospitals and that this phenomenon affected many hospitals.

  • 78.8%  of respondents perceived a decrease in the number of STEMI patients coming to their hospitals
  • According to them, the number of patients admitted to hospital had decreased by 50% on average

Many healthcare professionals also noted that STEMI patients who presented to hospitals did so later than usual.

  • 62.3% of respondents declared that STEMI patients presented later than usual (i.e. beyond the window for percutaneous coronary intervention (PCI)/thrombolysis)
  • The percentage of patients presenting later than usual was estimated to be 48% on average

Many cardiology departments have been impacted by the outbreak of the infection.

  • Up to 68% of respondents stated that the cardiology department had been ”partially” or “totally” restructured to accommodate infected patients

Detailed results

Robust worldwide data.

The survey gathered data from 3,101 respondents in 141 countries on six continents. 

  • 58% of respondents (n=1,800) were based in Europe
  • Fairly robust data were also collected from Asia (n=734)
 

Most respondents were cardiologists and interventional cardiologists from large hospitals.

  • More than 90% of respondents were cardiologists or interventional cardiologists
  • Overall, less than 10% were nurses or population health scientists
 

 

 

Respondents mostly worked in university and regional hospitals.

  • Only a minority of respondents worked in private hospitals (17% overall and 8% in Europe)
 

 

 

Most countries were locked-down at the time of the survey.

  • 88% of respondents were “totally” locked-down especially in Europe and the Americas
  • This was more strongly the case in Europe where 94% of respondents were in lockdown
Question: Is your country in lockdown (e.g. most shops and restaurants are closed, people are working from home as much as possible)?
 

 

 

Consequence #1 of the pandemic: There is a considerable decrease in STEMI patients coming to hospitals.

  • Nearly 80% of respondents perceived a decrease in the number of STEMI patients coming to hospital
  • Throughout the world, with only minor variations by geographical zones, most respondents reported a decrease in STEMI patients
Question: Have you perceived a change in the number of people coming to your hospital with STEMI since the coronavirus outbreak?
 

 

 

Respondents who noted a decrease in STEMI patients:

  • Nearly 65% of respondents perceived a greater than 41% fall in STEMI patients presenting to hospital. Some observed much greater reductions. On average, there was a 50% drop in STEMI patients coming to hospital
  • This was consistent throughout all regions except for South America where up to 75% declared a decrease of more than 41% in patients presenting with STEMI (with an average reaching 56% overall  in South America)
Question: By what percentage has the number of STEMI patients decreased?
 

 

 

Consequence #2 of the pandemic: STEMI patients present later than usual.

  • 62% of respondents estimated that STEMI patients present later than usual
  • In Europe, 64% of respondents said so vs. 54% in North America and 46% in Oceania
Question: Do STEMI patients present later than usual (i.e. beyond the optimal window for PCI/thrombolysis)?
 

 

 

Up to 65% of respondents estimated that at least 41% of STEMI patients present later than usual. Overall, on average, 48% of patients present later than usual. 

  • The overall trend is relatively consistent throughout all regions except for North America where hospitals seemed somewhat less affected by this
Question: What percentage of STEMI patients present later than usual (i.e. beyond the optimal window for PCI/thrombolysis)?
 

 

 

Consequence #3 of the pandemic: the huge wave of COVID patients also impacted cardiology departments.

  • Europe was the area with the most infected patients: up to 15% of respondents said that more than 200 infected patients were admitted to their hospital
  • In Europe alone, half of the respondents estimated that their hospital had received at least 51 infected patients
Question: How many patients are currently admitted to your hospital with COVID-19?
 

 

 

Up to 68% of respondents stated that their unit had been either “partially” or “totally” restructured as a result of the pandemic.

  • This trend was strongest in the Americas
Question: Has your ward/unit/department been restructured as a result of the COVID-19 pandemic?
 

 

For those reporting an increase in STEMI patients, the increase was marginal.

  • Only 3% of respondents reported an increase in STEMI patients
  • For up to 78% of those respondents who saw an increase, that increase ranged from 1% to 40%
  • There were many regional differences, but the samples are too small to be statistically comparable 
Question: By what percentage has the number of STEMI patients increased?
 

 

Only 3% of all respondents reported an increase in STEMI patients. For 30% of those respondents, the main reason for the increase in STEMI patients was “anxiety”.

  • Although the reported increase in STEMI patients was not statistically significant, 21% of European respondents indicated the key reason was “more STEMIs happening” followed by “health anxiety” (18%)
Question: What do you think the reasons for an increase are?
 

 

Visit our dedicated and extensive COVID-19 resources

The ESC's vast and diverse community has assembled this array of useful and important information. Read more.

Together, we learn from each other so that we can give our patients the best possible care. 

 

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  Mean % of results

 Increase/decrease of STEMI patients’ admissions in hospitals in countries with National (NCS) and Affiilated (ACS) Cardiac Societies.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.