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The rate of acute myocardial infarction (AMI)–related hospitalizations was reduced by more than 50% from February to May 2020 compared with the same time period in 2019. There was a corresponding 56% increase in the incidence of out-of-hospital cardiac arrest (OHCA) in 2020 during the COVID-19 period compared with the 2019 equivalent period. Compared with patients during the pre–COVID-19 period, patients with OHCA during the COVID-19 period were more likely to be older, female, and of Asian ethnicity and were more likely to present with STEMI. Among patients with OHCA, the rate of invasive coronary angiography was lower and the time to reperfusion increased in the COVID-19 period compared with the pre–COVID-19 period.
During the COVID-19 period, there has been an increase in the incidence of OHCA associated with reduced access to guideline-directed therapy.
This abstract is available on the publisher's site.
Studies have reported significant reduction in acute myocardial infarction (AMI) related hospitalizations during the COVID19 pandemic. However, whether these trends are associated with increased incidence of Out of Hospital Cardiac Arrest (OHCA) in this population is unknown.
Methods and Results
AMI hospitalizations with OHCA during the COVID19 period (1st February-14th May 2020) from the Myocardial Ischaemia National Audit Project and British Cardiovascular Intervention Society datasets were analysed. Temporal trends were assessed using Poisson models with equivalent pre-COVID19 period (1st February-14th May 2019) as reference. AMI hospitalizations during COVID19 period were reduced by more than 50% (n=20,310 vs n=9,325). OHCA was more prevalent during the COVID-19 period compared with the pre-COVID period (5.6% vs. 3.6%), with a 56% increase in the incidence of OHCA (incidence rate ratio: 1.56, 95%CI 1.39-1.74). OHCA patients during COVID19 period were likely to be older, female, of Asian ethnicity and more likely to present with STEMI. The overall rates of invasive coronary angiography (58.4% vs. 71.6%, p<0.001) were significantly lower amongst the OHCA during COVID19 period with increased time to reperfusion (mean 2.1 hours vs. 1.1 hours, p=0.05) in STEMI. The adjusted in-hospital mortality probability increased from 27.7% in February 2020 to 35.8% in May 2020 in the COVID19 group (p <0.001).
In this national cohort of hospitalized AMI patients, we observed a significant rise in incidence of OHCA during COVID period paralleled with reduced access to guidelines recommended care and increased in-hospital mortality.
Impact of COVID19 Pandemic on the Incidence and Management of Out of Hospital Cardiac Arrest in Patients Presenting With Acute Myocardial Infarction in England
J Am Heart Assoc 2020 Oct 07;[EPub Ahead of Print], M Rashid, CP Gale, N Curzen, P Ludman, M De Belder, A Timmis, MO Mohamed, TF Lüscher, J Hains, J Wu, A Shoaib, E Kontopantelis, C Roebuck, T Denwood, J Deanfield, MA Mamas