Study in Lithuania Shows Worse Outcomes From Heart Attack During COVID-19 Pandemic Compared to Previous Year

June 29, 2021—The European Society of Cardiology (ESC) announced the presentation of data demonstrating that heart attacks during the COVID-19 pandemic were more likely to result in heart failure compared with heart attacks 1 year earlier.

The retrospective, multicenter study covered six out of 10 administrative regions in Lithuania. Investigators compared treatment delays, posttreatment ejection fraction, and decompensated heart failure hospitalization rate in heart attack patients before the COVID-19 pandemic versus during the pandemic. The findings were presented at Heart Failure 2021, an online scientific congress of the ESC.

As summarized in the ESC announcement, the study included consecutive patients with acute myocardial infarction who received a negative test result for COVID-19 infection between March 11 and April 20, 2020, and underwent invasive treatment. The data were compared to patients admitted with the same diagnosis during the same period in 2019. Patients were followed up for 6 months following hospital discharge.

The investigators evaluated 269 heart attack patients. They found that there was a 34% decline in heart attack admissions during the early phase of the pandemic compared to the same period in 2019. Patients waited significantly longer before presenting at a hospital during the pandemic compared to 2019 (a median of 858 vs 386 minutes, respectively).

Admission rates and delays were less pronounced for ST-elevation myocardial infarction (STEMI) compared to non-STEMI. Admission rates fell by 22.1% for STEMI and 47.4% for non-STEMI. Patient delays more than doubled for STEMI patients during the pandemic and increased by more than fourfold for non-STEMI patients.

Posttreatment pump function was significantly lower during the pandemic compared to 2019. At 6 months, 22% of patients who had a heart attack during the pandemic were admitted to the hospital with decompensated heart failure compared to 2.5% in 2019.

When the investigators examined the results by type of heart attack, they found that at 6 months, approximately one-third of patients (30%) who had non-STEMI during the pandemic were admitted to the hospital for decompensated heart failure compared to 1.3% in 2019. For STEMI, the corresponding proportions of admissions were 16.4% during the pandemic versus 3.5% in 2019.

Study investigator Ali Aldujeli, MD, of the Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania, commented in the ESC press release, “Heart attack patients waited an average of 14 hours to get help during the pandemic, with some delaying for nearly 2 days. That compares to a delay of six hours in the previous year. This gap may have been one contributor to the higher incidence of subsequent heart failure.”

Dr. Aldujeli noted that the outcomes according to type of heart attack may have been influenced by new pandemic-specific protocols implemented to prevent spread of the virus. Patients diagnosed with STEMI according to an electrocardiogram were prioritized for urgent treatment (ie, without waiting for a COVID-19 test result) and staff used personal protective equipment (PPE) during the procedure. Patients with non-STEMI were deemed less urgent and were isolated for approximately 24 hours while waiting for COVID-19 test results, which dictated whether staff needed PPE during the procedure or not.

Dr. Aldujeli stated further, “Declines in admissions and delays in seeking treatment may be partly attributed to the extensive media coverage which amplified patients’ fear of contracting COVID-19 and precluded them from seeking timely medical care. A possible explanation for the differences according to type of heart attack could be because STEMI patients tend to have more acute and intense symptoms compared to those with non-STEMI.”

Dr. Aldujeli concluded in the ESC announcement, “Our findings suggest that all heart attacks during a pandemic should be treated urgently with staff using PPE. More balanced media coverage is also needed so that patients do not wait to seek help in medical emergencies.”