ABSTRACT
BackgroundA decrease in Emergency Department (ED) visits for cardiac conditions has recently been reported from the US and Western Europe due to the COVID-19 pandemic. The data are still scant, and the correlation between cardiac symptoms and confirmed diagnoses are not available. There are no reports on changes in ED volumes at a national level, or from countries in the Asia-Middle Eastern region. MethodsWe report data from national referral centers for tertiary care and cardiac care centers in Qatar, which see >80% of cardiac emergencies in the country. ResultsWe analyzed 102,033 ED visits in the COVID-era (March-April 2020 and 2019) and determined the proportion presenting for cardiac symptoms and their confirmed diagnoses. We observed a 16-37% decline in ED volumes overall, with a 25-50% decline in patients presenting with cardiac symptoms in March-April 2020 compared with March-April 2019. Among those presenting with cardiac symptoms, we observed a 24-43% decline in cardiac diagnoses. ConclusionsA sharp decline in patients presenting with cardiac symptoms was observed in the COVID-era. A post-COVID surge in patients with these conditions may be anticipated and preparations should be made to address it.
ABSTRACT
ObjectivesCoronavirus Disease 2019 (COVID-19) is a rapidly expanding global pandemic resulting in significant morbidity and mortality. COVID-19 patients may present with acute myocardial infarction (AMI). The aim of this study is to conduct detailed analysis on patients with AMI and COVID-19. MethodsWe included all patients admitted with AMI and actively known or found to be COVID-19 positive by PCR between the 4th February 2020 and the 11th June 2020 in the State of Qatar. Patients were divided into ST-elevation myocardial infarction (STEMI) and Non-STE (NSTEMI). ResultsThere were 68 patients (67 men and 1 woman) admitted between the 4th of February 2020 and the 11th of June 2020 with AMI and COVID-19. The mean age was 49.1{+/-}9 years, 46 patients had STEMI and 22 had NSTEMI. 38% had diabetes mellitus, 31% had hypertension, 16% were smokers, 13% had dyslipidemia, and 14.7% had prior cardiovascular disease. Chest pain and dyspnea were the presenting symptoms in 90% and 12% of patients, respectively. Fever (15%) and cough (15%) were the most common COVID-19 symptoms, while the majority had no viral symptoms. Thirty-nine (33 STEMI and 6 NSTEMI) patients underwent coronary angiography, 38 of them had significant coronary disease. In-hospital MACE was low; 1 patient developed stroke and 2 died. ConclusionContrary to previous small reports, in-hospital adverse events were low in this largest cohort of COVID-19 patients presenting with AMI. We hypothesize patients demographics and profile including younger age contributed to these findings. Further studies are required to confirm this observation. Key questionsO_ST_ABSWhat is already known on this subject?C_ST_ABSO_LICOVID-19 patients may present with acute myocardial infarction (AMI). C_LI What might this study add?O_LIContrary to previous small reports, most COVID-19 patients presenting with AMI have significant obstructive coronary artery disease and favorable in-hospital outcome. C_LI How might this impact on clinical practice?O_LICOVID-19 patients presenting with AMI should be treated according to the standard practice. C_LI
