During 2020 COVID-19 pandemic, acute MI hospitalizations down, in-hospital mortality up
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Key takeaways:
- During the first year of the COVID-19 pandemic, hospitalizations for acute MI fell compared with the previous year.
- However, in-hospital mortality rose and revascularization procedures declined.
Compared with 2019, in 2020, the first year of the COVID-19 pandemic, hospitalizations for acute MI were down but in-hospital mortality in that population rose in the U.S., researchers reported in the Korean Circulation Journal.
The researchers used the National Inpatient Sample database to compare U.S. hospitalizations for acute MI in 2020 compared with 2019, as well as in-hospital mortality and revascularization in those patients during those years.
“Our analysis was prompted by the significant impact of the COVID-19 pandemic on the health care system and its interactions with cardiovascular disease burden,” Anas Hashem, MD, chief medical resident in the internal medicine residency program at Rochester General Hospital in Rochester, New York, told Healio. “The pandemic led to the recognition of COVID-19-related acute myocardial injury, higher mortality rates among those with preexisting cardiac comorbidities, and a decrease in hospital admissions for myocardial infarction. Our study aimed to evaluate the impact of the early COVID-19 pandemic on trends and in-hospital outcomes of acute myocardial infarction using a large national database to provide contemporary data and improve preparedness for future pandemics.”
Hospitalization for acute MI fell from 209,450 in 2019 to 196,230 in 2020 for patients with STEMI (mean age, 64 years) and from 677,355 in 2019 to 626,445 in 2020 for patients with non-STEMI (mean age, 69 years; P for trend for both < .01), the researchers found.
Compared with patients with acute MI hospitalized in 2019, those hospitalized in 2020 had higher odds of in-hospital mortality (adjusted OR = 1.27; 95% CI, 1.23-1.32; P < .01) but lower odds of undergoing PCI (aOR = 0.95; 95% CI, 0.92-0.99; P = .02) or CABG (aOR = 0.9; 95% CI, 0.85-0.97; P < .01).
“The increased mortality figures were not entirely due to COVID-19 itself,” Hashem told Healio. “Multiple factors were likely at play at both patient and system levels, including delayed seeking of medical care due to fear of COVID-19 infection, delayed emergency medical service responses, reallocation of health system resources and changes in hospital protocols during the pandemic. These factors contributed to lower rates of diagnostic and revascularization procedures, delayed reperfusion and increased in-hospital mortality rates.”
There was also a higher mean total hospitalization cost in 2020 compared with 2019 (adjusted mean difference = $1,653; 95% CI, 967-2,340; P < .01), according to the researchers.
“The information from our study can be used to improve acute MI care by addressing barriers to acute cardiovascular care during pandemics and ensuring adherence to standards of care amid strained health care systems,” Hashem told Healio. “Future strategies should focus on delivering quality cardiovascular care during pandemics, including maintaining access to diagnostic and revascularization procedures, and evaluating system-based reasons behind delays in care. This could involve enhancing pandemic preparedness, optimizing resource allocation, and improving communication with patients to encourage timely seeking of care.”
For more information:
Anas Hashem, MD, can be reached at anas.hashem@rochesterregional.org.
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