A research letter published in Circulation Cardiovascular Quality and Outcomes may shed some light on the impact of the coronavirus (COVID-19) on ST-segment elevation myocardial infarction (STEMI) care.
A research team working out of Hong Kong looked at patients with STEMI who underwent primary percutaneous coronary intervention (PPCI) at a single center. The study began January 25 when the orders for emergency infection protocols to contain COVID-19 were implemented, to February 10. Their hospital suspended all non-essential visits and tweaked in- and out-patient services to accommodate the ill. They researchers collected data on key timepoints in the STEMI care process after patient diagnosis, including symptom-onset-to-first-medical-contact time, door-to-device time, and cath lab arrival-to-device time. Seven consecutive patients underwent PPCI during the course of the study. Their data were compared to those of 108 patients with STEMI treated with PPCI in the two prior years. None of the seven patients in the study contracted the COVID-19 virus.
COVID-19 Protocols May Increase Time to Care
According to the results, the authors observed changes in normal STEMI care time. Time from symptom-to-first-medical-contact was 318 minutes during the study time period compared with 82 minutes during office hours for the previous year, and 91.5 minutes during the non-office hours. Door-to-device time was 110 minutes compared with 84.5 minutes (129 minutes off-hours). Cath lab arrival-to-device time was also higher at 33 minutes during the study period compared with 20.5 minutes (24 minutes off-hours).
“We found large delays in the small number of patients with STEMI seeking medical help after institution of these [COVID-19] infection control measures,” the authors wrote in their letter. “It is understandable that people are reluctant to go to a hospital during the COVID-19 outbreak, which explains the potential delays in seeking care.”
The authors noted that effects COVID-19 protocols may impact the health care system in unexpected ways. Enhanced infection protocols, while necessary, can have downstream effects on STEMI and other critical care protocols.
“Although these are essential measures for containing COVID-19 infection, this could increase delays in diagnosis, staff activation and transfer if healthcare systems are not prepared,” they wrote. “Similarly, even after patients arrived in the catheterization laboratory, staff may need more time to wear protective gear to prepare the patients and interventional cardiologists may not be used to performing PPCI while in full protective gear, leading to longer treatment.”
The researchers noted that the research was preliminary and that the experience was limited to a single care center, noting that improvement over time is possible.
“In modern society, infectious agents like the COVID-19 outbreak can spread quickly and evolve into a pandemic,” they concluded. “Hospitals not only need to consider methods for containing and treating these infections but how infection outbreaks may affect systems of care beyond the immediate infection.”
Aftershocks can be as deadly as the quake.@CircOutcomes letter & editorial describe potential impact of COVID-19 on patients even W/O the virus👇🏾@iamrituhttps://t.co/yqlHL3mkPShttps://t.co/N2CqhH294j pic.twitter.com/Nv334LewWC
— Brahmajee Nallamothu (@bnallamo) March 17, 2020
Article on STEMI Care during COVID19 and our (myself and Dr Alfredo Mena Lora from ID) editorial on the need to “Be Prepared” to keep up with acute cardiovascular care during the pandemic. @UICDom @UIC_CathLab @mividovich @ElliottMGroves https://t.co/NpwEjJ2qG8
— Amer Ardati (@spiritus_bah) March 17, 2020
Great piece. All of us are thinking about how to deal with this now. There is clear tradeoff between risk of staff vs risk of patient. My sense is best to keep the routine, use more protective gear. Get the artery open and get out. https://t.co/R0PT53f1bU
— Dennis Ko (@denniskomd) March 17, 2020
🚨 HOT OFF THE PRESSES! 🚨
What effects will COVID-19 have on patients needing acute care?
Prelim data from Hong Kong just published in @CircOutcomes give us a hint…
Quickfire #CQOSpotlight below!@bnallamo @mad_sters @boback @iamritu @spiritus_bah https://t.co/tQ4uOa1jP0
— Mike Thompson (@MikeTPhD) March 17, 2020