Key result
During the peak of the COVID-19 pandemic in Germany, key quality indicators for STEMI care, including the proportion of patients achieving contact-to-balloon times ≤ 90 minutes, remained unaffected compared to previous years.
Why the study?
The study was conducted to assess the impact of the COVID-19 lockdown on key quality indicators for the treatment of STEMI patients.
Does the COVID-19 pandemic lockdown impact key quality indicators and mortality in patients presenting with STEMI?
Observational (n=15,800)
Yes
Does the COVID-19 pandemic lockdown impact key quality indicators and mortality in patients presenting with STEMI?
Effect estimate: Difference 0.5% (95% CI -6.2-7.2)
Absolute Event Rate: 57.8% vs 58.3%
p-value: p=0.879
Clinically important indicators for STEMI management, including contact-to-balloon times and in-hospital mortality, were unaffected at the peak of the COVID-19 pandemic in Germany, demonstrating the resilience of established regional STEMI networks.
Fewer STEMI patients treated during lockdown may indicate care avoidance; leaves open resilient system planning for future crises.
AIMS: To assess the impact of the lockdown due to coronavirus disease 2019 (COVID-19) on key quality indicators for the treatment of ST-segment elevation myocardial infarction (STEMI) patients. METHODS: Data were obtained from 41 hospitals participating in the prospective Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) study, including 15,800 patients treated for acute STEMI from January 2017 to the end of March 2020. RESULTS: There was a 12.6% decrease in the total number of STEMI patients treated at the peak of the pandemic in March 2020 as compared to the mean number treated in the March months of the preceding years. This was accompanied by a significant difference among the modes of admission to hospitals (p = 0.017) with a particular decline in intra-hospital infarctions and transfer patients from other hospitals, while the proportion of patients transported by emergency medical service (EMS) remained stable. In EMS-transported patients, predefined quality indicators, such as percentages of pre-hospital ECGs (both 97%, 95% CI = - 2.2-2.7, p = 0.846), direct transports from the scene to the catheterization laboratory bypassing the emergency department (68% vs. 66%, 95% CI = - 4.9-7.9, p = 0.641), and contact-to-balloon-times of less than or equal to 90 min (58.3% vs. 57.8%, 95%CI = - 6.2-7.2, p = 0.879) were not significantly altered during the COVID-19 crisis, as was in-hospital mortality (9.2% vs. 8.5%, 95% CI = - 3.2-4.5, p = 0.739). CONCLUSIONS: Clinically important indicators for STEMI management were unaffected at the peak of COVID-19, suggesting that the pre-existing logistic structure in the regional STEMI networks preserved high-quality standards even when challenged by a threatening pandemic. CLINICAL TRIAL REGISTRATION: NCT00794001.
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Scholz et al. (2020) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=15,800). COVID-19 lockdown (March 2020) vs. Preceding March months (2017-2019) was evaluated on Contact-to-balloon time ≤ 90 min in EMS-transported patients (Difference 0.5%, 95% CI -6.2-7.2, p=0.879). During the peak of the COVID-19 pandemic in Germany, key quality indicators for STEMI care, including the proportion of patients achieving contact-to-balloon times ≤ 90 minutes, remained unaffected compared to previous years.
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