Key result
During the COVID-19 pandemic, patients with acute myocardial infarction and comorbid diabetes experienced higher disease severity, including a higher rate of intensive care unit admission (60.3% vs 57.1%, p<0.001), compared to those without diabetes.
Why the study?
Nationwide data were limited on the link between emergency service disruption and AMI outcomes during the COVID-19 pandemic, and whether diabetes mellitus adversely affects disease severity was uninvestigated.
Does the COVID-19 pandemic and comorbid diabetes mellitus affect emergency care utilization and disease severity in patients with acute myocardial infarction?
Cohort (n=45,648)
Yes
Does the COVID-19 pandemic and comorbid diabetes mellitus affect emergency care utilization and disease severity in patients with acute myocardial infarction?
The COVID-19 pandemic was associated with delayed emergency care and increased disease severity in AMI patients, with disproportionately worse impacts observed in those with comorbid diabetes.
Comorbid diabetes signals higher AMI severity risk in pandemics; leaves open targeted strategies to reduce delays and mortality.
Background Although acute myocardial infarction (AMI) requires timely intervention, limited nationwide data is available regarding the association between disruption of emergency services and outcomes of patients with AMI during the coronavirus disease 2019 (COVID-19) pandemic. Moreover, whether diabetes mellitus (DM) adversely affects disease severity in these patients has not yet been investigated. Methods This nationwide population-based study analyzed 45,648 patients with AMI, using data from the national registry of emergency departments (ED) in Korea. Frequency of ED visits and disease severity were compared between the COVID-19 outbreak period (year 2020) and the control period (the previous year 2019). Results The number of ED visits by patients with AMI decreased during the first, second, and third waves of the outbreak period compared to the corresponding time period in the control period (all p -values < 0.05). A longer duration from symptom onset to ED visit ( p = 0.001) and ED stay ( p = 0.001) and higher rates of resuscitation, ventilation care, and extracorporeal membrane oxygen insertion were observed during the outbreak period than during the control period (all p -values < 0.05). These findings were exacerbated in patients with comorbid DM; Compared to patients without DM, patients with DM demonstrated delayed ED visits, longer ED stays, more intensive care unit admissions ( p < 0.001), longer hospitalizations ( p < 0.001), and higher rates of resuscitation, intubation, and hemodialysis (all p -values < 0.05) during the outbreak period. While in-hospital mortality was similar in AMI patients with and without comorbid DM during the two periods (4.3 vs. 4.4%; p = 0.671), patients with DM who had other comorbidities such as chronic kidney disease or heart failure or were aged ≥ 80 years had higher in-hospital mortality compared with those without any of the comorbidities (3.1 vs. 6.0%; p < 0.001). Conclusion During the pandemic, the number of patients with AMI presenting to the ED decreased compared with that of the previous year, while the disease severity increased, particularly in patients with comorbid DM.
No takes yet. Share an insight, caveat, or question.
Song et al. (2023) conducted a cohort in Acute myocardial infarction (n=45,648). Comorbid diabetes mellitus during the COVID-19 pandemic vs. Patients without diabetes mellitus was evaluated on Intensive care unit (ICU) admission rate (p=<0.001). During the COVID-19 pandemic, patients with acute myocardial infarction and comorbid diabetes experienced higher disease severity, including a higher rate of intensive care unit admission (60.3% vs 57.1%, p<0.001), compared to those without diabetes.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: