Key result
The COVID-19 pandemic was associated with a significant 8% reduction in acute coronary syndrome presentations (95% CI 4-11; p<0.001) and an 18% increase in Type II myocardial injury.
Why the study?
The study was conducted to identify changes in cardiovascular disease presentation, emergency room triage, and inpatient diagnostic and therapeutic pathways during the COVID-19 pandemic.
Does the COVID-19 pandemic alter cardiovascular disease presentation, triage, and inpatient services in a low- to middle-income country?
Cohort (n=2,976)
No
Does the COVID-19 pandemic alter cardiovascular disease presentation, triage, and inpatient services in a low- to middle-income country?
Effect estimate: 8% reduction (95% CI 4-11)
p-value: p=<0.001
The COVID-19 pandemic was associated with a significant decline in presentations for acute coronary syndrome and heart failure, decreased cardiovascular procedures, and a surge in Type II myocardial injury in a Pakistani tertiary care center.
Altered CVD pathways during COVID warrant caution in future outbreaks; leaves open questions on outcomes and optimal triage.
Aims: To identify the changes in cardiovascular disease presentation, emergency room triage and inpatient diagnostic and therapeutic pathways. Methods: We conducted a retrospective cohort study at the Aga Khan University Hospital, Karachi. We collected data for patients presenting to the emergency department with cardiovascular symptoms between March-July 2019 (pre-COVID period) and March-July 2020 (COVID period). The comparison was made to quantify the differences in demographics, clinical characteristics, admission, diagnostic and therapeutic procedures, and in-hospital mortality between the two periods. Results: Of 2976 patients presenting with cardiac complaints to the emergency department (ED), 2041(69%) patients presented during the pre-COVID period, and 935 (31%) patients presented during the COVID period. There was significant reduction in acute coronary syndrome (ACS) (8% [95% CI 4-11], p < 0.001) and heart failure (↓6% [95% CI 3-8], p < 0.001). A striking surge was noted in Type II Myocardial injury (↑18% [95% CI 20-15], p < 0.001) during the pandemic. There was reduction in cardiovascular admissions (coronary care unit p < 0.01, coronary step-down unit p = 0.03), cardiovascular imaging (p < 0.001), and procedures (percutaneous coronary intervention p = 0.04 and coronary angiography p = 0.02). No significant difference was noted in mortality (4.7% vs. 3.7%). The percentage of patients presenting from rural areas declined significantly during the COVID period (18% vs. 14%, p = 0.01). In the subgroup analysis of sex, we noticed a falling trend of intervention performed in females during the COVID period (8.2% male vs. 3.3 % female). Conclusions: This study shows a significant decline in patients presenting with Type I myocardial infarction (MI) and a decrease in cardiovascular imaging and procedures during the COVID period. There was a significant increase noted in Type II MI.
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Adnan et al. (2021) conducted a cohort in cardiovascular symptoms (n=2,976). COVID-19 pandemic period (March-July 2020) vs. Pre-COVID period (March-July 2019) was evaluated on presentation with acute coronary syndrome (ACS) (8% reduction, 95% CI 4-11, p=<0.001). The COVID-19 pandemic was associated with a significant 8% reduction in acute coronary syndrome presentations (95% CI 4-11; p<0.001) and an 18% increase in Type II myocardial injury.
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