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As documented in many reports, the COVID-19 pandemic has been linked to reductions in hospitalizations for acute myocardial infarction, among many other acute conditions. Investigators embarked on a study to determine the changes in admissions for acute coronary syndromes (ACS) in all 147 acute hospitals throughout England from January 1, 2019, to May 24, 2020.
In 2020, from mid-February through the end of March, hospital admissions for ACS fell by 40%, compared with the rate in 2019. This change, however, was temporary; by the last week of May, hospital admissions were only 16% below what had occurred in the previous year. The reduction in admissions was smaller for ST-segment elevation myocardial infarction (STEMI) than for non-STEMI. By the end of March, the number of percutaneous coronary interventions declined by 21% in STEMI patients and 37% in non-STEMI patients. The median length of stay fell by a day by the end of March, compared with 2019.
Mafham MM et al. COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England. Lancet 2020 Jul 14; S0140-6736(20)31356-8; [e-pub]. (https://doi.org/10.1016/S0140-6736(20)31356-8)
Comment
This report from England is consistent with many others indicating that admissions for ACS dropped initially and then rebounded. Interestingly, the decline started 2 weeks before the first U.K. death from COVID-19 and a month before the U.K. lockdown. The study has limitations, including incomplete data, reliance on administrative codes, and no information on delays in presentation or deaths. We still lack insight as to the causes and consequences of these changes in admission rates. There is a persistent concern that ill people are avoiding hospitals out of fear during the pandemic, but cleaner air and evolving health-related behaviors might also have roles in these patterns. We have more to learn here.