MI Hospitalizations Fall, Mortality Rises During Pandemic in US

By Will Boggs MD

August 11, 2020

NEW YORK (Reuters Health) - Acute myocardial infarction (AMI) hospitalizations decreased and mortality rates have increased in the COVID-19 pandemic, according to a retrospective U.S. study.

"This study adds to the growing body of literature that has noted adverse outcomes among non-communicable diseases during the pandemic," Dr. Tyler J. Gluckman from Providence St. Joseph Health, Portland, Oregon told Reuters Health by email. "It also reinforces that while social distancing with COVID-19 is recommended, medical distancing is not. (#StopMedicalDistancing)"

Numerous reports have noted substantial decreases in hospitalization rates for AMI since the beginning of the COVID-19 pandemic.

Dr. Gluckman and colleagues evaluated trends in AMI hospitalizations before and after the onset of the pandemic at 49 hospitals located in six US states.

Before the onset of the COVID-19 pandemic, the mean weekly case rate was 222 patients for AMI, including 72 patients with ST-elevation myocardial infarction (STEMI) and 150 patients with non-STEMI.

Beginning in late February 2020, AMI hospitalizations decreased at the rate of 19 cases per week for 5 weeks (the early COVID-19 period) before increasing at a rate of 10.5 cases per week thereafter, according to the online report in JAMA Cardiology.

Weekly hospitalizations for AMI had not returned to baseline by mid-May 2020, the last week evaluated.

Treatment approaches did not differ across periods, but median length of stay for patients with AMI decreased from 63 hours before the pandemic to 56 hours in the early COVID-19 period and 57 hours in the late COVID-19 period.

Compared with patients hospitalized before the pandemic, patients hospitalized for AMI during the pandemic were slightly younger, were more likely to be Asian or Native American, had a shorter length of stay, and were more likely to be discharged home.

Overall, in-hospital mortality rates were similar between periods. However, patients with STEMI had 52% greater odds of mortality during the later COVID-19 period than before the pandemic.

"Given the time-sensitive nature of STEMI, any delay by patients, emergency medical services, the emergency department, or cardiac catheterization laboratory may have major consequences," Dr. Gluckman said. "Accordingly, any patient with symptoms or signs of an AMI should be encouraged to seek immediate medical attention."

"Because the timing of a vaccine is currently unknown, our study also reinforces the need to address important care processes for patients with AMI to help mitigate further risk," he said.

Dr. Gluckman added, "Further research is needed to identify factors associated with the higher observed mortality rate, particularly among those with STEMI."

Dr. Matthew D. Solomon from Kaiser Permanente, East Bay, Oakland, California, who recently addressed the incidence of AMI during the COVID-19 pandemic, told Reuters Health by email, "The rapid reversal in AMI rates after the early COVID-19 period suggests patients may have adjusted to the pandemic, and much of the 'fear factor' may have decreased once patients adjusted to our new reality. But we still need to know if the residual lower-than-normal AMI rates reflect a true reduction in heart attack rates - due to better sleep, or a change in lifestyle or other habits - or whether that is a lingering consequence of fear of going to the hospital."

"Public health officials and health systems must educate the public that our hospitals are safe and that patients must seek care for any concerning symptoms," he said. "With the rigorous safety policies hospitals have implemented, they may be one of the safest places."

"We must continue to evaluate our care patterns during this uncertain time and rigorously track and monitor whether a pandemic of fear remains," Dr. Solomon said. "We continue to battle not only COVID-19 pandemic, but also the pandemic of fear."

Dr. Chor Cheung "Frankie" Tam from the University of Hong Kong, who recently reviewed the impact of the COVID-19 outbreak on STEMI care there, told Reuters Health by email, "COVID-19 has reshaped our living and our healthcare system. The infection can kill people directly, but the indirect effect on non-COVID patients and diseases (e.g., AMI, cancer) also adversely affects the outcomes. The 'collateral damage' stems from change in patient behavior, healthcare professionals' attitude, infection control measures, and resource availability, etc."

"We know that COVID-19 is important and our priority; we have to protect our patients, ourselves, our family and friends," he said. "However, we should not forget other patients and diseases. We acknowledge there will be limitations, but at least we have to try our best to do something to protect non-COVID-19 patients."

Dr. Tam added, "One thing we frequently overlook is patients' mental health, as well as their caregivers'. We have seen cases where patients' relatives cannot even see their dying loved ones because of COVID-19 hospital policy. This is very sad."

SOURCE: https://bit.ly/30GUQj6 JAMA Cardiology, online August 7, 2020.