Delayed care for acute MI during pandemic peak may be tied to elevated HF hospitalization
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During the peak of the COVID-19 pandemic, there was a significant delay for patients presenting with acute MI to seek medical care, which may be linked to a spike in rehospitalization for HF at 6 months, researchers reported.
Ali Aldujeli, MD, MSc, from the Lithuanian University of Health Sciences in Kaunas, Lithuania, and colleagues conducted a region-wide, multicenter, retrospective cohort study that included 269 consecutive patients with acute MI (116 non-STEMI and 153 STEMI) and a negative COVID-19 test from March to April 2020 in Lithuania. Patients were compared with those hospitalized with the same diagnosis from March to April 2019.
The primary outcomes were in-hospital outcomes and 6-month major adverse CV events, including death due to CV, nonfatal MI, target vessel revascularization, stroke and HF rehospitalization.
Results from the 6-month follow-up period, presented at the Heart Failure and World Congress on Acute Heart Failure virtual meeting, demonstrated longer pain-to-door times (858 minutes vs. 385.5 minutes; P < .0001) and troponin I levels (7.8 µg/L vs. 4.5 µg/L; P = .013) among patients with acute MI during the COVID-19 pandemic compared with patients before the pandemic. The difference occurred in patients with non-STEMI (2,021 minutes vs. 558 minutes; P < .0001) and STEMI (582 minutes vs. 262 minutes; P = .0003). The researchers also found there was a trend toward longer door-to-wire times in patients with non-STEMI during the pandemic compared with before it (302.5 minutes vs. 200.5 minutes; P = .0948); there was no difference in patients with STEMI (P = .2257).
During the COVID-19 pandemic, compared with before the pandemic, there was a higher HF rehospitalization rate at 6 months among patients with non-STEMI (30% vs. 1.3%; P < .0001) and STEMI (16.4% vs. 3.5%; P = .005).
Overall major adverse CV events at 6 months were higher in patients treated during the pandemic compared with those treated before the pandemic (30.8% vs. 13.6%; P = .0006), but the results were driven by those with non-STEMI (45% vs. 11.8%; P < .0001), whereas there was no difference in those with STEMI (pandemic, 22.4%; pre-pandemic, 15.1%; P = .2485), Aldujeli said during the presentation.
“A possible explanation for the differences according to type of heart attack could be because STEMI patients tend to have more acute and intense symptoms compared to those with non-STEMI,” Aldujeli said in a press release.
“This study cannot establish causality, eg, the increase in heart failure hospitalizations may be due to decreased medical compliance, poor outpatient follow-up, decreased access to cardiac rehabilitation,” Aldujeli said during his presentation. “When implementing lockdowns for contagion control in a pandemic scenario, it is important to emphasize when individuals should seek emergent medical attention.”
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Aldujeli A, et al. Abstract 60073. Presented at: Heart Failure and World Congress on Acute Heart Failure; June 29-July 1, 2021 (virtual meeting).
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