Impact of COVID19 Pandemic on the Incidence and Management of Out of Hospital Cardiac Arrest in Patients Presenting with Acute Myocardial Infarction in England

Rashid, Muhammad; Gale, Chris P.; Curzen, Nick; Ludman, Peter; De Belder, Mark; Timmis, Adam; Mohamed, Mohamed O.; Lüscher, Thomas F.; Hains, Julian; Wu, Jianhua; Shoaib, Ahmad; Kontopantelis, Evangelos; Roebuck, Chris; Denwood, Tom; Deanfield, John; Mamas, Mamas

Abstract

Background: Studies have reported significant reduction in acute myocardial infarction (AMI) related hospitalizations during the COVID19 pandemic. However, whether these trends are associated with increased incidence of Out of Hospital Cardiac Arrest (OHCA) in this population is unknown.

Methods & Results: AMI hospitalizations with OHCA during the COVID19 period (1st February-14th May 2020) from the Myocardial Ischaemia National Audit Project and British Cardiovascular Intervention Society datasets were analysed. Temporal trends were assessed using Poisson models with equivalent pre-COVID19 period (1st February-14th May 2019) as reference.

AMI hospitalizations during COVID19 period were reduced by more than 50% (n=20,310 vs n=9,325). OHCA was more prevalent during the COVID-19 period compared with the pre-COVID period (5.6% vs. 3.6%), with a 56% increase in the incidence of OHCA (incidence rate ratio: 1.56, 95%CI 1.39-1.74). OHCA patients during COVID19 period were likely to be older, female, of Asian ethnicity and more likely to present with STEMI. The overall rates of invasive coronary angiography (58.4% vs. 71.6%, p<0.001) were significantly lower amongst the OHCA during COVID19 period with increased time to reperfusion (mean 2.1 hours vs. 1.1 hours, p=0.05) in STEMI. The adjusted in-hospital mortality probability increased from 27.7% in February 2020 to 35.8% in May 2020 in the COVID19 group (p <0.001).

Conclusions: In this national cohort of hospitalized AMI patients, we observed a significant rise in incidence of OHCA during COVID period paralleled with reduced access to guidelines recommended care and increased in-hospital mortality.

Citation

Rashid, M., Gale, C. P., Curzen, N., Ludman, P., De Belder, M., Timmis, A., Mohamed, M. O., Lüscher, T. F., Hains, J., Wu, J., Shoaib, A., Kontopantelis, E., Roebuck, C., Denwood, T., Deanfield, J., & Mamas, M. (2020). Impact of COVID19 Pandemic on the Incidence and Management of Out of Hospital Cardiac Arrest in Patients Presenting with Acute Myocardial Infarction in England. Journal of the American Heart Association Cardiovascular and Cerebrovascular Disease, 9(22), https://doi.org/10.1161/JAHA.120.018379

• Journal Article Type: Article
• Acceptance Date: Sep 21, 2020
• Online Publication Date: Oct 7, 2020
• Publication Date: Nov 17, 2020
• Publicly Available Date: May 26, 2023
• Journal: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
• Print ISSN: 2047-9980
• Electronic ISSN: 2047-9980
• Publisher: Wiley Open Access
• Peer Reviewed: Peer Reviewed
• Volume: 9
• Issue: 22
• DOI: https://doi.org/10.1161/JAHA.120.018379
• Keywords: Out of hospital cardiac arrest, Incidence, COVID19, acute myocardial infarction, mortality
• Public URL: https://keele-repository.worktribe.com/output/418050
• Publisher URL: https://www.ahajournals.org/doi/10.1161/JAHA.120.018379