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COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England.
Mafham, Marion M; Spata, Enti; Goldacre, Raphael; Gair, Dominic; Curnow, Paula; Bray, Mark; Hollings, Sam; Roebuck, Chris; Gale, Chris P; Mamas, Mamas A; Deanfield, John E; de Belder, Mark A; Luescher, Thomas F; Denwood, Tom; Landray, Martin J; Emberson, Jonathan R; Collins, Rory; Morris, Eva J A; Casadei, Barbara; Baigent, Colin.
  • Mafham MM; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Oxford, UK.
  • Spata E; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Oxford, UK.
  • Goldacre R; Big Data Institute, Nuffield Department of Population Health, Oxford, UK.
  • Gair D; NHS Digital, Leeds, UK.
  • Curnow P; NHS Digital, Leeds, UK.
  • Bray M; NHS Digital, Leeds, UK.
  • Hollings S; NHS Digital, Leeds, UK.
  • Roebuck C; NHS Digital, Leeds, UK.
  • Gale CP; Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
  • Mamas MA; Keele Cardiovascular Research Group, Institute for Prognosis Research, University of Keele, Keele, UK.
  • Deanfield JE; Institute of Cardiovascular Sciences, University College London, London, UK.
  • de Belder MA; National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK.
  • Luescher TF; Imperial College, National Heart and Lung Institute, London, UK; Royal Brompton and Harefield Hospitals, London, UK.
  • Denwood T; NHS Digital, Leeds, UK.
  • Landray MJ; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Oxford, UK; Big Data Institute, Nuffield Department of Population Health, Oxford, UK
  • Emberson JR; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Oxford, UK.
  • Collins R; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Oxford, UK.
  • Morris EJA; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Oxford, UK; Big Data Institute, Nuffield Department of Population Health, Oxford, UK.
  • Casadei B; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, UK.
  • Baigent C; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Oxford, UK. Electronic address: colin.baigent@ndph.ox.ac.uk.
Lancet ; 396(10248): 381-389, 2020 08 08.
Article in English | MEDLINE | ID: covidwho-642223
Semantic information from SemMedBD (by NLM)
1. COVID-19 CAUSES Hospital Administration
Subject
COVID-19
Predicate
CAUSES
Object
Hospital Administration
2. Hospital admission TREATS Acute Coronary Syndrome
Subject
Hospital admission
Predicate
TREATS
Object
Acute Coronary Syndrome
3. Myocardial Infarction PROCESS_OF Patients
Subject
Myocardial Infarction
Predicate
PROCESS_OF
Object
Patients
4. Acute Coronary Syndrome PROCESS_OF Patients
Subject
Acute Coronary Syndrome
Predicate
PROCESS_OF
Object
Patients
5. Secondary Prevention TREATS Coronary Arteriosclerosis
Subject
Secondary Prevention
Predicate
TREATS
Object
Coronary Arteriosclerosis
6. Coronary Arteriosclerosis PROCESS_OF Patients
Subject
Coronary Arteriosclerosis
Predicate
PROCESS_OF
Object
Patients
7. Secondary Prevention TREATS Patients
Subject
Secondary Prevention
Predicate
TREATS
Object
Patients
8. Acute Coronary Syndrome AFFECTS COVID-19
Subject
Acute Coronary Syndrome
Predicate
AFFECTS
Object
COVID-19
9. COVID-19 CAUSES Hospital Administration
Subject
COVID-19
Predicate
CAUSES
Object
Hospital Administration
10. Hospital admission TREATS Acute Coronary Syndrome
Subject
Hospital admission
Predicate
TREATS
Object
Acute Coronary Syndrome
11. Myocardial Infarction PROCESS_OF Patients
Subject
Myocardial Infarction
Predicate
PROCESS_OF
Object
Patients
12. Acute Coronary Syndrome PROCESS_OF Patients
Subject
Acute Coronary Syndrome
Predicate
PROCESS_OF
Object
Patients
13. Secondary Prevention TREATS Coronary Arteriosclerosis
Subject
Secondary Prevention
Predicate
TREATS
Object
Coronary Arteriosclerosis
14. Coronary Arteriosclerosis PROCESS_OF Patients
Subject
Coronary Arteriosclerosis
Predicate
PROCESS_OF
Object
Patients
15. Secondary Prevention TREATS Patients
Subject
Secondary Prevention
Predicate
TREATS
Object
Patients
16. Acute Coronary Syndrome AFFECTS COVID-19
Subject
Acute Coronary Syndrome
Predicate
AFFECTS
Object
COVID-19
ABSTRACT

BACKGROUND:

Several countries affected by the COVID-19 pandemic have reported a substantial drop in the number of patients attending the emergency department with acute coronary syndromes and a reduced number of cardiac procedures. We aimed to understand the scale, nature, and duration of changes to admissions for different types of acute coronary syndrome in England and to evaluate whether in-hospital management of patients has been affected as a result of the COVID-19 pandemic.

METHODS:

We analysed data on hospital admissions in England for types of acute coronary syndrome from Jan 1, 2019, to May 24, 2020, that were recorded in the Secondary Uses Service Admitted Patient Care database. Admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), myocardial infarction of unknown type, or other acute coronary syndromes (including unstable angina). We identified revascularisation procedures undertaken during these admissions (ie, coronary angiography without percutaneous coronary intervention [PCI], PCI, and coronary artery bypass graft surgery). We calculated the numbers of weekly admissions and procedures undertaken; percentage reductions in weekly admissions and across subgroups were also calculated, with 95% CIs.

FINDINGS:

Hospital admissions for acute coronary syndrome declined from mid-February, 2020, falling from a 2019 baseline rate of 3017 admissions per week to 1813 per week by the end of March, 2020, a reduction of 40% (95% CI 37-43). This decline was partly reversed during April and May, 2020, such that by the last week of May, 2020, there were 2522 admissions, representing a 16% (95% CI 13-20) reduction from baseline. During the period of declining admissions, there were reductions in the numbers of admissions for all types of acute coronary syndrome, including both STEMI and NSTEMI, but relative and absolute reductions were larger for NSTEMI, with 1267 admissions per week in 2019 and 733 per week by the end of March, 2020, a percent reduction of 42% (95% CI 38-46). In parallel, reductions were recorded in the number of PCI procedures for patients with both STEMI (438 PCI procedures per week in 2019 vs 346 by the end of March, 2020; percent reduction 21%, 95% CI 12-29) and NSTEMI (383 PCI procedures per week in 2019 vs 240 by the end of March, 2020; percent reduction 37%, 29-45). The median length of stay among patients with acute coronary syndrome fell from 4 days (IQR 2-9) in 2019 to 3 days (1-5) by the end of March, 2020.

INTERPRETATION:

Compared with the weekly average in 2019, there was a substantial reduction in the weekly numbers of patients with acute coronary syndrome who were admitted to hospital in England by the end of March, 2020, which had been partly reversed by the end of May, 2020. The reduced number of admissions during this period is likely to have resulted in increases in out-of-hospital deaths and long-term complications of myocardial infarction and missed opportunities to offer secondary prevention treatment for patients with coronary heart disease. The full extent of the effect of COVID-19 on the management of patients with acute coronary syndrome will continue to be assessed by updating these analyses.

FUNDING:

UK Medical Research Council, British Heart Foundation, Public Health England, Health Data Research UK, and the National Institute for Health Research Oxford Biomedical Research Centre.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Acute Coronary Syndrome / Pandemics / Hospitalization Type of study: Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Lancet Year: 2020 Document Type: Article Affiliation country: S0140-6736(20)31356-8

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Acute Coronary Syndrome / Pandemics / Hospitalization Type of study: Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Lancet Year: 2020 Document Type: Article Affiliation country: S0140-6736(20)31356-8