Infectious Disease

Delayed treatment for acute MI during the pandemic peak may be related to increased HF hospitalization

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Aldujeli A, et al. Abstract 60073. Presented at: Heart Failure and World Congress on Acute Heart Failure; June 29th – July 1st, 2021 (virtual meeting).

Disclosure:
Aldujeli does not report any relevant financial information.

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During the height of the COVID-19 pandemic, patients with acute MI experienced a significant delay in seeking medical attention, which could be linked to an increase in re-hospitalization for HF after 6 months, researchers reported.

Ali Aldujeli, MD, MSc, from the Lithuanian University of Health Sciences in Kaunas, Lithuania, and colleagues conducted a region-wide, multicenter, retrospective cohort study that enrolled 269 consecutive patients with acute MI (116 non-STEMI and 153 STEMI) and a negative COVID-19 test of March to April 2020 in Lithuania. Patients were compared with those hospitalized from March to April 2019 with the same diagnosis.

Someone is clutching the heart

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The primary endpoints were hospital outcomes and major cardiovascular adverse reactions at 6 months including death from CV, non-fatal myocardial infarction, target vessel revascularization, stroke, and HF re-hospitalization.

Results from the 6-month follow-up presented at the Virtual Heart Failure Meeting and World Acute Heart Failure Congress showed longer pain-to-home times (858 minutes vs. 385.5 minutes; P <0.0001) and troponin I (7.8 µg / L vs. 4.5 µg / L; p = 0.013) in patients with acute MI during the COVID-19 pandemic compared to patients before the pandemic. The difference occurred in patients with non-STEMI (2,021 minutes vs. 558 minutes; P <0.0001) and STEMI (582 minutes vs. 262 minutes; P = 0.0003). The researchers also found that during the pandemic there was a trend towards longer door-to-wire times in patients with non-STEMI compared to before (302.5 minutes vs. 200.5 minutes; P = .0948) ; there was no difference in patients with STEMI (P = 0.2257).

During the COVID-19 pandemic, there was a higher HF re-hospitalization rate in patients with non-STEMI (30% vs. 1.3%; P <0.0001) and STEMI (16.4% vs. 3.5) 6 months than before the pandemic%; P = 0.005)).

Overall, serious cardiovascular side effects at 6 months were higher in patients treated during the pandemic than in patients treated before the pandemic (30.8% vs. 13.6%; P = 0.0006), but the Results were different from those with non-STEMI (45% vs. 11.8%; P <0.0001), while there was no difference in those with STEMI (pandemic, 22.4%; pre-pandemic, 15.1%) ; P = 0.2485), said Aldujeli during the presentation.

“One possible explanation for the differences between the types of myocardial infarction could be that STEMI patients are prone to more acute and intense symptoms compared to non-STEMI patients,” Aldujeli said in a press release.

“This study cannot prove causality, e.g. For example, the increase in hospital admissions for heart failure may be due to reduced medical compliance, poor outpatient follow-up care, limited access to cardiac rehabilitation, ”said Aldujeli during his presentation. “When implementing bans to control contagion in a pandemic scenario, it is important to emphasize when people should seek urgent medical attention.”

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