During the COVID-19 pandemic, heart attacks were more likely to end in severe heart failure compared to the previous year, according to results presented at Heart Failure 2021, an online conference organised by the European Society of Cardiology (1). Worryingly, the team found that patients with less severe heart attacks were more likely to need to be re-admitted to the hospital within six months than those who suffered a complete blockage because they were not seen as needing urgent care. The researchers advocate that, during the pandemic, all heart attacks should be treated as urgent.
Urgent care for patients suffering a heart attack is vital to ensure oxygen flow to the heart. If patients endure a long time without oxygen, they’re more likely to suffer damage to the heart muscle and end up with a defective pump function, both signs of heart failure.
The study presented in the conference compared waiting times for treatment and hospitalisation rates due to heart failure in heart attack patients before and during the COVID-19 pandemic from six areas in Lithuania. The study included patients with a negative test result for COVID-19 infection between March and April 2020, who underwent treatment for acute myocardial infarction. These results were then compared with patients hospitalised with a similar diagnosis during the same period in 2019. All 269 patients from both study periods received regular check-ups for six months after leaving the hospital.
There was a 34% drop in hospital admissions due to heart attack, and patients had to wait longer for treatment during the pandemic compared to the same period in 2019. “Heart attack patients waited an average of 14 hours to get help during the pandemic, with some delaying for nearly two days. That compares to a delay of six hours in the previous year,” said author Dr Ali Aldujeli of the Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania. “This gap may have been one contributor to the higher incidence of subsequent heart failure.”
Curiously, the waiting times also depended on the actual heart condition. Treatment was more expedite for serious heart attacks with complete blockage of the heart arteries (known as STEMI), but these patients still had to wait twice as long during the pandemic compared to the previous year. Worse than that, patients with less severe heart attacks with partial or temporary coronary artery blockages (non-STEMI) had to endure a fourfold delay to receive treatment.
“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 the type of heart attack could be because STEMI patients tend to have more acute and intense symptoms compared to those with non-STEMI”, explained Dr Aldujeli.
Somewhat counterintuitively, the team found that it was more likely for patients with a less serious non-STEMI condition to be re-admitted into hospital for heart failure within six months compared to patients who had suffered a STEMI heart attack. In contrast, in 2019, STEMI patients were three times more likely to end up in the hospital again with heart failure.
The team believes these outcomes were influenced by protocols to deal with heart attack patients developed explicitly during the pandemic. Patients with a complete blockage were often prioritised to receive treatment even without a negative covid-19 result. On the other hand, patients with a partial blockage were seen as less urgent and had to endure some time in isolation until the results of their covid-19 tests were available.
“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”, concluded Dr Aldujeli.
(1) Aldujeli A, Hamadeh A, Tecson K, Krivickas Z, Maciulevicius L, Stiklioraitis S, Briedis K, Aldujeili M, Haq A, Braukyliene B, Pranculis A, Unikas R, Zaliaduonyte D, Mccullough P (2021) Association between delayed revascularization during the covid-19 pandemic and rates of post myocardial infarction heart failure hospitalizations. Heart Failure 2021 & World Congress on Acute Heart Failure