Impact of COVID-19 lockdown on STEMI admissions ‘substantial,’ driving poorer outcomes
Delaying or stopping STEMI treatment during the first COVID-19-related lockdown in England was associated with approximately 2 life-years lost per patient vs. pre-lockdown conditions, according to a modeling analysis presented at EuroPCR.
In an analysis to predict the potential clinical and economic burden associated with reductions in PCI treatment access during the COVID-19 lockdown in England, researchers said the difference was primarily driven by the reduced hospitalization rate at the start of lockdown and by a higher mortality rate in the long term for untreated survivors.
“We spend a lot of time trying to convince authorities and regulatory bodies that if you implement new treatments, there is going to be an impact on patient outcomes,” William Wijns, MD, Science Foundation Ireland Professor in Interventional Cardiology at the Lambe Institute for Translational Medicine, Curam and Saolta University Healthcare Group, National University of Ireland, Galway, said during a press conference. “Here, we had an unfortunate experiment, where existing care was removed [during lockdown]. This gives us the opportunity to look at the impact.”
Modeling STEMI patient data
Wijns and colleagues developed a decision-analytic model to predict outcomes for STEMI occurring during the first U.K. lockdown from March to April 2020 and compared rates with expected pre-lockdown outcomes for an equivalent patient group. The model incorporated probability of hospitalization, timeliness of treatment and projected long-term survival and morbidity, as well as associated costs and the impact on HF for untreated patients.
“Some authorities in many countries issued stay-at-home orders and, of course, the hospitals reorganized their care pathways completely. ... CV treatments were postponed, delayed or even did not take place,” Wijns said. “The most acute part of that was the reduction of treatment in patients with STEMI.”
The researchers stratified patients by hospitalization status; those hospitalized were designated to timely or late PCI; nonhospitalized patients did not receive PCI within 30 days. Researchers estimated 30-day mortality for each case; patients then entered the long-term survival model with outcomes based on treatment status.
The model predicted an average loss of 1.86 years of survival for a patient having a STEMI during the first month of lockdown compared with pre-lockdown, with a corresponding 1.46 loss of quality-adjusted life-years, according to researchers. Scaled up to a population level, the findings translated to a loss of 4,912 years of survival with a corresponding 3,856 loss of QALYs.
“This means that having a STEMI during the COVID-19 lockdown period caused an average loss of nearly 2 years of life per patient vs. someone having a STEMI prior to lockdown, driven primarily by the reduced hospitalization rate at the start of lockdown but also due to higher mortality rate over time because untreated patients suffer more complications,” Wijns said. “They more often move into HF and have more severe arrythmias.”
Lessons learned from lockdowns
Wijns called the impact of the COVID-19 lockdown on STEMI admissions and PCI use “substantial,” leading to poorer patient outcomes including increased mortality, more HF, higher societal costs and lower QALYs.
STEMI admissions did recover quickly; however, there was a similar removal of care during the second wave of COVID-19 lockdowns in the U.K. in November 2020, Wijns said. During a Q&A session after the press conference, Wijns said he hoped clinicians and researchers would “take lessons” from the data.
“For example, unpreparedness would no longer be an issue if subsequent waves [of COVID-19] hit us,” Wijns said. “We want to have an impact on hospitals and physicians, but we also want to produce a list of diseases where treatment could not be stopped or interrupted. There would be a plan, so we would not be taken by surprise.”
Wijns added the data also underscored the importance of nurses and allied health professionals.
“We still see that some cath labs have not returned to normal because of the lack of nurses and allied professionals,” he said.
As Healio previously reported, the Society for Cardiovascular Angiography and Interventions, the American College of Cardiology and the American College of Emergency Physicians issued a consensus statement in April 2020 stating that primary PCI should continue to be the standard of care for patients with STEMI during the COVID-19 pandemic. The statement noted that all patients with suspected STEMI should be treated as COVID-19 possible, adding patients should be transferred to the cardiac catheterization laboratory as quickly as possible, although more time may be needed to establish an acute MI diagnosis and/or to perform a COVID-19 status assessment and treatment.
Wijns said additional STEMI data from France, Spain, Sweden and the United States is forthcoming; researchers also hope to extend the analysis to other countries and other disease areas.
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Wijns W, et al. Primary PCI: New Issues, New Solutions. Presented at: EuroPCR; May 17-20, 2022; Paris (hybrid meeting).
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