COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England
COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England
复制标题
DOI：
10.1016/s0140-6736(20)31356-8
复制
发表时间：
2020-08-08
期刊：
影响因子：
168.9
通讯作者：
Baigent, Colin
中科院分区：
文献类型：
--
作者：
Mafham, Marion M.;Spata, Enti;Baigent, Colin
一些受COVID-19大流行影响的国家报告称，急诊急性冠状动脉综合征患者数量大幅下降，心脏手术数量减少。我们的目的是了解英格兰不同类型急性冠状动脉综合征入院变化的规模、性质和持续时间，并评估患者的住院管理是否受到COVID-19大流行的影响。方法：我们分析了2019年1月1日至2020年5月24日英国二级用药服务住院患者护理数据库中记录的各类急性冠状动脉综合征住院数据。入院患者分为st段抬高型心肌梗死（STEMI）、非STEMI （NSTEMI）、不明类型心肌梗死或其他急性冠状动脉综合征（包括不稳定型心绞痛）。我们确定了在这些入院期间进行的血运重建手术（即无经皮冠状动脉介入造影[PCI]， PCI和冠状动脉搭桥手术）。我们计算了每周的入院人数和所采取的程序；还计算了周入院率和亚组间的减少百分比，ci为95%。急性冠状动脉综合征入院率从2020年2月中旬开始下降，从2019年每周3017例的基线率下降到2020年3月底的每周1813例，减少了40% （95% CI 37-43）。这种下降在2020年4月和5月部分逆转，到2020年5月的最后一周，入院人数为2522人，比基线减少16% （95% CI 13-20）。在入院人数下降期间，所有类型的急性冠状动脉综合征的入院人数都有所减少，包括STEMI和NSTEMI，但NSTEMI的相对和绝对减少幅度更大，2019年每周入院1267人，到2020年3月底每周入院733人，减少了42% （95% CI 38-46）。与此同时，STEMI（2019年每周438次PCI手术，到2020年3月底为346次；减少21%，95% CI 12-29）和NSTEMI（2019年每周383次PCI手术，到2020年3月底为240次；减少37%，29-45）患者的PCI手术次数也有所减少。急性冠状动脉综合征患者住院时间中位数由2019年的4天（IQR 2-9）降至2020年3月底的3天（1-5）。与2019年的周平均水平相比，截至2020年3月底，英国每周入院的急性冠状动脉综合征患者人数大幅减少，到2020年5月底，这一趋势已部分逆转。在此期间入院人数的减少可能导致院外死亡和心肌梗死的长期并发症的增加，并错过了为冠心病患者提供二级预防治疗的机会。将通过更新这些分析，继续评估COVID-19对急性冠状动脉综合征患者管理的全面影响。版权所有(c) 2020作者Elsevier Ltd.出版。这是一篇基于CC BY 4.0许可的开放获取文章。
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. Copyright (c) 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.